Introduction Burn patients with inhalation injury requiring mechanical ventilation (MV) are at particular risk for ventilator-associated pneumonia (VAP), which is associated with increased morbidity and mortality. Routine endotracheal surveillance cultures (SC) may provide information about the causative pathogen in subsequent VAP, facilitating early appropriate antibiotic therapy.
Objectives To assess the value of routine endotracheal SC to predict multidrug resistant (MDR) aetiology of VAP in burn patients with inhalation injury.
Methods Historical cohort (N=46) study including all burn patients with inhalation injury who developed VAP during admission to the burn unit at Ghent University Hospital (2002–2009).
Results Overall, 70 episodes of VAP occurred. Median age and total burned surface area were 43.5 y (IQR 38.0 to 54.3) and 32.5% (18.0 to 45.8) respectively. The median Belgian Outcome in Burn Injury score was 5 (4–6), reflecting a predicted mortality of 30% (20–50%).1 Median duration of MV prior to onset VAP was 7d (4–9d). The incidence of VAP was 55 episodes/1000 MV days and 112 episodes/1000 MV days “at risk.” In 23 episodes (32.9%) at least one MDR causative pathogen was involved (24 MDR pathogens), mostly Pseudomonas aeruginosa (10/23) and Enterobacter spp. (7/23). The sensitivity and specificity of SC to predict MDR pathogens was respectively 83.0% and 96.2%, corresponding with a positive predictive value of 87.0% and a negative predictive value of 95.0%. Subgroup analyses showed higher predictive values for second VAP episodes, and when P aeruginosa was involved.
Conclusions In this cohort routine SC appear to have excellent operating characteristics to predict MDR involvement in VAP.
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