Staphylococcal pneumonia in ventilated patients: a twelve-month review of cases in an intensive care unit

Inglis, T. J. J.; Sproat, L.J.; Hawkey, Peter M.; Gibson, J.

doi:10.1016/0195-6701(93)90039-3

Cited by 22 publications

(7 citation statements)

References 3 publications

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“…8,11 Biofilm has been shown to accumulate most regularly in the distal aspect of the tube, while it is less detectable in the more proximal tube regions. 14 Bacterial structures have been detected within the luminal biofilm on electron microscopy in up to 68% of specimens. 3,9,13 Some authors have reported that these microbes are not found on the surfaces of the biofilm, but rather are visible deep within the cracks and fissures.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Electron Microscopic Analysis of Biofilm on Endotracheal Tubes Removed from Intubated Neonates

Zur

Mandell

Gordon

et al. 2004

Otolaryngol.--head neck surg.

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Section: Discussionmentioning

confidence: 99%

“…One possibility is that these represent aspiration of secretions from the oropharynx, a site that is notorious for colonization with Gramnegative bacilli in mechanically ventilated patients 10,15 . Another possible source is from aspiration of gastric or duodenal secretions contaminated with Gram‐negative bacilli 14,15 …”

Section: Discussionmentioning

confidence: 99%

Electron Microscopic Analysis of Biofilm on Endotracheal Tubes Removed from Intubated Neonates

Zur

Mandell

Gordon

et al. 2004

Otolaryngol.--head neck surg.

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“…but Staphylococcus aureus is also important [5,6]. The usual causes are endogenous bacteria, including those colonising the stomach and oropharynx of the ICU patient [7,81.…”

Section: Introductionmentioning

confidence: 99%

Comparison of bronchoalveolar lavage and catheter lavage to confirm ventilator-associated lower respiratory tract infection

Humphreys¹,

Winter²,

Baker³

et al. 1996

Journal of Medical Microbiology

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Lower respiratory tract infection (LRTI) is a well recognised complication of artificial ventilation in intensive care units (ICU). Ideally, specimens for microbiological analysis should be obtained during bronchoscopy, but this is not always possible. Therefore, the microbiological diagnosis of lower respiratory tract infection by broncho-alveolar lavage (BAL) obtained during bronchoscopy was compared with catheter lavage (CL) with a balloon-tipped catheter. Adult patients with clinical evidence of lower respiratory tract infection in an adult ICU were randomly assigned to undergo BAL followed by CL or vice versa. Forty ml of normal saline 0.9% were instilled and then aspirated with a flexible bronchoscope to obtain BAL. A similar volume was instilled and aspirated with a 12-gauge Foley balloon-tipped catheter to obtain a C L sample. The number of inflammatory cells, epithelial cells and organisms seen by microscopy were quantified. Culture results were semi-quantified and classified as negative, positive, equivocal or contaminated. Seventy-nine paired specimens were obtained from 66 patients, including specimens from 10 patients taken on two or more occasions. Only 20% of BAL and 16% of CL had one or more epithelial cells and bacteria were seen in 26 BAL and 21 CL specimens, respectively; 35% of BAL and CL specimens were positive and there was a discrepancy in the culture result in only two cases. Staphylococcus aureus was the pathogen isolated most frequently and polymicrobial lower respiratory infection was diagnosed on 10 occasions (15%). CL fluid is as reliable as BAL in diagnosing lower respiratory tract infection in ICU. This approach does not require bronchoscopic expertise and utilises convenient laboratory techniques.

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“…Nosocomial bacterial pneumonias are frequently polymicrobial (4,7,9,11,12,(15)(16)(17)(18)(19), and gram-negative bacilli are usually the predominant organisms (Table_1) (2)(3)(4)(5)(6)9,(11)(12)(13). However, Staphylococcus aureus (especially methicillin-resistant S. aureus) (5,7,10,15,20,21) and other gram-positive cocci, including Streptococcus pneumoniae (5,7), have emerged recently as important isolates (14). In addition, Haemophilus influenzae has been isolated from mechanically ventilated patients who had pneumonia that occurred within 48-96 hours after intubation (3)(4)(5)12,15,22).…”

Section: Bacterial Pneumonia I Etiologic Agentsmentioning

confidence: 99%

Guidelines for Prevention of Nosocomial Pneumonia

1997

PsycEXTRA Dataset

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This revised guideline is designed to reduce the incidence of nosocomial pneumonia and is intended for use by personnel who are responsible for surveillance and control of infections in acute-care hospitals; the information may not be applicable in long-term-care facilities because of the unique characteristics of such settings. This revised guideline addresses common problems encountered by infection-control practitioners regarding the prevention and control of nosocomial pneumonia in U.S. hospitals. Sections on the prevention of bacterial pneumonia in mechanically ventilated and/or critically ill patients, care of respiratory-therapy devices, prevention of cross-contamination, and prevention of viral lower respiratory tract infections (e.g., respiratory syncytial virus {RSV} and influenza infections) have been expanded and updated. New sections on Legionnaires disease and pneumonia caused by Aspergillus sp. have been included. Lower respiratory tract infection caused by Mycobacterium tuberculosis is not addressed in this document. Part I, "An Overview of the Prevention of Nosocomial Pneumonia, 1994," provides the background information for the consensus recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC) in Part II, "Recommendations for Prevention of Nosocomial Pneumonia." Pneumonia is the second most common nosocomial infection in the United States and is associated with substantial morbidity and mortality. Most patients who have nosocomial pneumonia are infants, young children, and persons greater than 65 years of age; persons who have severe underlying disease, immunosuppression, depressed sensorium, and/or cardiopulmonary disease; and persons who have had thoracoabdominal surgery. Although patients receiving mechanically assisted ventilation do not represent a major proportion of patients who have nosocomial pneumonia, they are at highest risk for acquiring the infection. Most bacterial nosocomial pneumonias occur by aspiration of bacteria colonizing the oropharynx or upper gastrointestinal tract of the patient. Because intubation and mechanical ventilation alter first-line patient defenses, they greatly increase the risk for nosocomial bacterial pneumonia. Pneumonias caused by Legionella sp., Aspergillus sp., and influenza virus are often caused by inhalation of contaminated aerosols. RSV infection usually occurs after viral inoculation of the conjunctivae or nasal mucosa by contaminated hands. Traditional preventive measures for nosocomial pneumonia include decreasing aspiration by the patient, preventing cross-contamination or colonization via hands of personnel, appropriate disinfection or sterilization of respiratory-therapy devices, use of available vaccines to protect against particular infections, and education of hospital staff and patients. New measures being investigated involve reducing oropharyngeal and gastric colonization by pathogenic microorganisms.

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Staphylococcal pneumonia in ventilated patients: a twelve-month review of cases in an intensive care unit

Cited by 22 publications

References 3 publications

Electron Microscopic Analysis of Biofilm on Endotracheal Tubes Removed from Intubated Neonates

Electron Microscopic Analysis of Biofilm on Endotracheal Tubes Removed from Intubated Neonates

Comparison of bronchoalveolar lavage and catheter lavage to confirm ventilator-associated lower respiratory tract infection

Guidelines for Prevention of Nosocomial Pneumonia

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