Effects of systemic antibiotic therapy on bacterial persistence in the respiratory tract of mechanically ventilated patients |
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Authors: | Stefan Visscher Carolina A M Schurink Wilhelmina G Melsen Peter J F Lucas Marc J M Bonten |
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Institution: | (1) Department of Internal Medicine & Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands;(2) Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands;(3) Institute for Computing and Information Sciences, Radboud University Nijmegen, Nijmegen, The Netherlands;(4) Eijkman Winkler Institute for Microbiology, Inflammation & Infectious Diseases, HP G04.614, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands |
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Abstract: | Objective Bacterial respiratory tract colonization predisposes critically ill patients to intensive care unit (ICU)-acquired infections.
It is unclear to what extent systemic antibiotics affect colonization persistence. Persistence of respiratory tract colonization,
and the effects of systemic antibiotics hereon, were determined in a cohort of ICU patients.
Design Clinical and microbiological data were collected from 715 admitted mechanically ventilated ICU patients with bacterial growth
documented in respiratory tract samples. First day of colonization, persistence of colonization and antibiotic effects hereon
were analyzed for six groups of pathogens: Pseudomonas aeruginosa, Acinetobacter species, Enterobacteriaceae, Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae. Systemic antibiotics were grouped into ‘effective’ and ‘ineffective’ antibiotics, based on in-vitro susceptibility data
for the relevant bacteria. The effects of antibiotics were quantified as relative risk (RR) of bacterial persistence in the
absence of effective antibiotics.
Measurements and results Persistence of colonization differed significantly between pathogens, ranging from 4 days (median) for H. influenzae and Strep. pneumoniae to 8 days for P. aeruginosa. Systemic antibiotics were administered on 7,102 (61%) of patient days. Antibiotic use was associated with non-persistence
for all pathogens, except Acinetobacter species and P. aeruginosa. RR for non-persistence (as compared to ineffective or no antibiotics) ranged from 3.1 (95% CI 1.4–6.6) for H. influenzae to 0.5 (0.3–1.0) for Acinetobacter species.
Conclusions In mechanically ventilated patients, persistence dynamics of bacterial respiratory tract colonization, and the effects of
(in-vitro) effective antibiotics hereon, are pathogen-specific. |
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Keywords: | Respiratory tract colonization Bacterial persistence Antibiotic use |
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