Interpreting positive cultures of endotracheal aspirates: Factors associated with treatment decisions in ventilated neonates

Murila, Florence; Francis, Johny Vakayil; Bland, Amy E.; Kumbla, Surekha; Doherty, Richard; Sehgal, Arvind

doi:10.1111/j.1440-1754.2011.02041.x

Cited by 8 publications

(13 citation statements)

References 22 publications

(23 reference statements)

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“…3,7,[10][11] We found that almost half of our population had multiple colonisations, a finding consistent across studies. 4,21 Murila et al found 32% of their population had multiple microorganisms isolated. 4 Neonatal CLD remains the most significant contributor to morbidity in preterm infants.…”

Section: Discussionmentioning

confidence: 99%

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Bacterial colonisation of the endotracheal tube in ventilated very preterm neonates: A retrospective cohort study

Antoine

Inglis

Way

et al. 2020

J Paediatrics Child Health

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Aim: To determine the rate, type and timing of bacterial endotracheal tube (ETT) colonisation in neonates born <32 weeks gestational age (GA); and if bacterial colonisation is associated with chronic lung disease (CLD), septicaemia, length-of-stay or mortality. Methods: All intubated newborns born <32 weeks GA were included. Endotracheal aspirates were routinely obtained three times-per-week. Cohort was divided into three colonisation groups: no growth, normal respiratory flora only, significant bacteria. Logistic regression was performed to identify if ETT bacterial colonisation was associated with CLD, septicaemia or mortality. A general linear model was fitted for lengthof-stay. Results: ETT aspirates were sent from 1054 infants: no growth n = 319, only normal respiratory flora n = 357, and significant bacteria n = 378. ETTs became colonised in 70%, most in the first week of life (82%). Most grew normal respiratory flora (642 infants). In those with significant bacteria, 40% grew Gram-negative species; Klebsiella in 34%. Staphylococcus aureus grew in 104 patients. Adjusted odds ratios for CLD (43% of cohort) compared with no growth were, for normal respiratory flora, 0.58 (95% confidence interval (CI) 0.34-0.99) and, for significant bacteria, 0.48 (95% CI 0.24-0.93). With no overall association between colonisation group and CLD in the adjusted model P = 0.07. The odds of septicaemia (10% of cohort) were 4.50 (95% CI 1.98-10.23, P < 0.001) times greater for significant bacteria compared with no growth. No significant associated was found with mortality or length-of-stay. Conclusions: Bacterial colonisation of ETTs is common. It is associated with more septicaemia. There was no significant association with CLD, longer admission or mortality.

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Section: Discussionmentioning

confidence: 99%

“…Differing perspectives remain in the literature as to which bacteria are significant and when treatment should occur. 4 The timing of bacterial colonisation of a neonate's ETT varies; occurring within days to weeks. 3,[5][6][7] A longer duration of intubation increases the likelihood of bacterial colonisation.…”

Section: What This Paper Addsmentioning

confidence: 99%

Bacterial colonisation of the endotracheal tube in ventilated very preterm neonates: A retrospective cohort study

Antoine

Inglis

Way

et al. 2020

J Paediatrics Child Health

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“…3 The oropharyngeal flora of critically ill patients changes from mainly gram-positive organisms to mainly gram-negative organisms, which are much more virulent, especially within 48 hours of hospitalization. 8,14 This more virulent flora can move into the lungs, leading to hospital-acquired pneumonia. The odds of acquiring an infection due to gram-negative microorganisms are much higher in patients treated with mechanical ventilation than in patients who do not receive this therapy.…”

Section: Intervention and Prevention Strategiesmentioning

confidence: 99%

“…The odds of acquiring an infection due to gram-negative microorganisms are much higher in patients treated with mechanical ventilation than in patients who do not receive this therapy. 8,14 Use of a stress ulcer prophylaxis, such as sucralfate, that does not increase gastric pH can decrease the risk for VAP but still prevent ulcer formation. 12 In adults, the incidence of VAP was lower in patients treated with sucralfate than in patients treated with H 2 -receptor antagonists.…”

Section: Intervention and Prevention Strategiesmentioning

confidence: 99%

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Preventing Ventilator-Associated Pneumonia in Children: An Evidence-Based Protocol

Cooper

Haut

2013

Critical Care Nurse

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A s a hospital-acquired infection (HAI), ventilator-associated pneumonia (VAP) is associated with additional complications for patients in the pediatric intensive care unit (PICU). Despite the volume of published information on VAP in adults, the amount of research on VAP in children is limited. Health care providers need to be aware of the risk for VAP in infants and children and should have preventive programs in place. Evidence-based protocols that outline preventive and therapeutic treatments for specific situations for adults treated with mechanical ventilation have been developed, but little has been offered for the care of children receiving mechanical ventilation. Ventilator-associated pneumonia, the second most common hospital-acquired infection in pediatric intensive care units, is linked to increased morbidity, mortality, and lengths of stay in the hospital and intensive care unit, adding tremendously to health care costs. Prevention is the most appropriate intervention, but little research has been done in children to identify necessary skills and strategies. Critical care nurses play an important role in identification of risk factors and prevention of ventilator-associated pneumonia. A care bundle based on factors, including evidence regarding the pathophysiology and etiology of pneumonia, mechanical ventilation, duration of ventilation, and age of the child, can offer prompts and consistent prevention strategies for providers caring for children in the pediatric intensive care unit. Following the recommendations of the Centers for Disease Control and Prevention and adapting an adult model also can support this endeavor. Ultimately, the bedside nurse directs care, using best evidence to prevent this important health care problem. (Critical Care Nurse. 2013;33[3]:21-30) by AACN on May 12, 2018 http://ccn.aacnjournals.org/ Downloaded from

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Special Considerations in Neonatal Mechanical Ventilation

Dalgleish

Kostecky

Charania

2016

Critical Care Nursing Clinics of North America

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Interpreting positive cultures of endotracheal aspirates: Factors associated with treatment decisions in ventilated neonates

Abstract: Treated culture-positive aspirate episodes were accompanied by higher ventilatory requirements, increased symptoms and elevated septic markers. Need for treatment was associated with greater likelihood of developing chronic lung disease.

Cited by 8 publications

References 22 publications

Bacterial colonisation of the endotracheal tube in ventilated very preterm neonates: A retrospective cohort study

Bacterial colonisation of the endotracheal tube in ventilated very preterm neonates: A retrospective cohort study

Preventing Ventilator-Associated Pneumonia in Children: An Evidence-Based Protocol

Special Considerations in Neonatal Mechanical Ventilation

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