Abstract
Klebsiella pneumoniae (K. pneumoniae) and Acinetobacter baumannii (A. baumannii) are multiresistant pathogens most frequently found in patients hospitalized in the Intensive Care of our hospital. We found the highest rate of positivity in the bronchial aspirates, often followed by a similar observation in blood culture. We carried out a study to evaluate the reduction of sepsis that developed after the detection of these microorganisms in bronchial aspirate, following the introduction of treatment with colistin aerosol in combination with conventional therapy. From 2012 to the first half of 2014, 533 patients were admitted to the ICU of our hospital. Since May 2013, colistin was administered by aerosol along with conventional therapy. In 43 (78.1%) cases K. pneumoniae KPC was isolated from bronchial aspirate and in 30 (54.5%) from blood culture; MDR A. baumannii was isolated in 89 (96.7%) cases of bronchial aspirate and 45 (48.9%) from blood culture. From patients treated with added colistin aerosol, K. pneumoniae KPC was isolated from bronchial aspirates in 15 cases and in 4 (26.7%) of those was found sepsis. MDR A. baumannii was isolated from bronchial aspirate in 41 cases, and in 10 (24.4%) it developed sepsis due to the same germ. The patients admitted to intensive care for more than 7 days were positive for MDR A. baumannii and MDR K. pneumoniae in bronchial aspirates and subsequent relief of blood culture. The treatment with colistin aerosol resulted in a reduction of the spread of microorganisms from the lower respiratory tract to the blood.
Highlights
The incidence of nosocomial respiratory infections is relevant in ICU patients undergoing assisted ventilation [1]
In the group of patients treated with conventional therapy alone, 28 were found positive for K. pneumoniae KPC in bronchial aspirate, and 13 patients (46.4%) of these developed sepsis caused by the same organism; in 48 patients MDR A. baumannii was isolated from bronchial aspirates and in 22 patients (45.8%) MDR A. baumannii was isolated from blood culture
In the time elapsed since the aerosol therapy was introduced in May 2013, 15 cases were found positive for K. pneumoniae KPC in bronchial aspirate and 41 tested positive for MDR A. baumannii
Summary
The incidence of nosocomial respiratory infections is relevant in ICU patients undergoing assisted ventilation [1]. We have verified that the reduction of positivity coincided with the introduction, for these patients, of treatment with colistin aerosol, we conducted a study to assess whether the combination of colistin aerosol with the conventional treatment is able to reduce the incidence of sepsis as a complication of pneumonia due to MDR K. pneumoniae and MDR A. baumannii in patients admitted to the ICU of our hospital. On the basis of the length of their stay in ICU, patients were divided
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