• The Journal of infection · Jan 2008

    The incidence and microbial spectrum of ventilator-associated pneumonia after tracheotomy in a selective decontamination of the digestive tract-setting.

    • Denise P Veelo, Tomas Bulut, Dave A Dongelmans, Johanna C Korevaar, Peter E Spronk, and Marcus J Schultz.
    • Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. d.p.veelo@amc.uva.nl
    • J. Infect. 2008 Jan 1;56(1):20-6.

    ObjectivesTracheotomy is considered to be an independent risk factor for ventilator-associated pneumonia (VAP). Antimicrobial prophylaxis, in particular with coverage of Pseudomonas aeruginosa, is presently advocated. Selective decontamination of the digestive tract (SDD) aims to prevent VAP in critically ill patients, including those after tracheotomy. We determined the incidence and microbial spectrum of VAP after tracheotomy in a SDD-setting.MethodsRetrospective analysis of 231 tracheotomized patients during a 2-year period.ResultsThirteen patients (5.6%) developed VAP. The median [IQR] day of onset was 8.0 [3.0-10.5] days after tracheotomy. The most predominant causative pathogen was Methicillin-sensitive Staphylococcus aureus (MSSA). Timing of tracheotomy was not different between patients developing VAP and those who did not. The type of tracheotomy (percutaneous or surgical, 84.6% versus 15.4%) had no significant influence on the incidence of VAP.ConclusionsThe incidence of VAP after tracheotomy in a SDD-setting is low, with MSSA as the predominant causative pathogen. Accordingly, if antimicrobial prophylaxis is considered, it may be advisable to cover MSSA in an SDD-setting.

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