인공호흡기연관 폐렴의 경험적 항생제 선택 시 이전 호흡기검체의 유용성

• Published in: Tuberculosis and respiratory diseases Vol. 72; no. 1; pp. 30 - 36
• Main Authors: 김지혜, Ji Hye Kim, 윤성철, Sung Chul Yoon, 이유미, Yu Mi Lee, 손지웅, Ji Woong Son, 최유진, Eu Gene Choi, 나문준, Moon Jun Na, 권선중, Sun Jung Kwon
• Format: Journal Article
• Language: Korean
• Published: 대한결핵 및 호흡기학회 01.01.2012; 대한결핵및호흡기학회
• Subjects: Pneumonia; Ventilator-Associated; Bronchoalveolar Lavage; Anti-Bacterial Agents; 내과학; Bronchoalveolar Lavage; Anti-Bacterial Agents; Pneumonia, Ventilator-Associated
• ISSN: 1738-3536; 2005-6184

Patients with ventilator-associated pneumonia (VAP) in intensive care unit (ICU) have a high mortality rate. The routine surveillance cultures obtained previously or an ATS guideline for hospital-acquired pneumonia was used in selecting initial antimicrobials. The object of this study was to compare the respiratory samples before VAP and bronchoalveolar lavage (BAL) culture.54 patients underwent fiberoptic bronchoscopy to obtain BAL samples. We reviewed microbiologic specimen results of prior respiratory specimens (pre-VAP) and BAL. Among 51 patients with 54 VAP episodes, 52 microorganisms of pre-VAP and 56 BAL samples were isolated. Pre-VAP included 21.2% of MRSA, and 32.6% of multidrug resistant- Acinetobacter baumannii (MDR-AB). BAL samples comprised 25.0% of MRSA, 26.7% of MDR-AB, 14.3% of Stenotrophomonas maltophilia and 3.6% of Klebsiella pneumonia in order. In pre-VAP samples compared to BAL samples, only 35.2% were identical. In BAL samples compared to pre-VAP samples obtained in 5 days before the onset of VAP, only 43.6% were identical. However, among BAL samples compared to pre-VAP samples obtained after more than 5 days, 13.3% were identical (p=0.037). Based on these data, pre-VAP samples obtained prior to 5 day onset of VAP may help to predict the causative microorganisms and to select appropriate initial antimicrobials.