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(Chest. 2005;128:273-279.)
© 2005 American College of Chest Physicians

Respiratory Microbiology Patterns Within the First 24 h of ARDS Diagnosis*

Influence on Outcome

Torsten T. Bauer, MD; Mauricio Valencia, MD; Joan R. Badia, MD; Santiago Ewig, MD, FCCP; Julià González, MD; Miguel Ferrer, MD and Antoni Torres, MD, FCCP

* From Institut de Pneumologia i Cirugía Toracica (Drs. Bauer, Valencia, Badia, Ewig, Ferrer, and Torres), Servei de Microbiologia (Dr. González), Hospital Clinic, Institut de Investigacions Biomédique August PiISunyer, Universitat de Barcelona, Barcelona, Spain.

Correspondence to: Antoni Torres, MD, FCCP, Hospital Clìnic de Barcelona, Servei de Pneumologia i Cirogía Toracica, Villarroel 170, 08036 Barcelona, Spain; e-mail: atorres{at}medicina.ub.es

Background: Airway colonization and infection are frequent complications during the course of ARDS. The impact on outcomes of microbiological patterns recovered within the first 24 h after diagnosis has not been evaluated.

Objectives: To describe the incidence and patterns of bronchial colonization and lung infection within the first 24 h of ARDS diagnosis and to evaluate the influence on ICU outcomes.

Methods: Prospective study of ARDS patients evaluated within 24 h of diagnosis. Patients were studied with tracheobronchial aspirate and right and left bronchoscopic protected specimen brush. All samples were cultured quantitatively.

Results: Fifty-five consecutive patients were included. Twelve patients (22%) were clinically suspected of having nosocomial pneumonia (NP), which was confirmed microbiologically in 7 patients, a frequency of 13%. In those patients without suspected pneumonia, we also found potentially pathogenic microorganisms (PPMs) and potentially drug-resistant microorganisms (PDRMs) in 36% and 31%, respectively. Mortality was not significantly higher in those patients with recovery of a PPM (87% vs 73%, p = 0.31), PDRM (89% vs 74%, p = 0.18), or with NP (79% vs 85%, p = 1.0).

Conclusion: There is a strikingly high rate of PPM recovery in early ARDS. However, neither isolation of pathogenic microorganisms nor the confirmation of NP could be associated with an increased mortality.

Key Words: ARDS • colonization • nosocomial pneumonia • pulmonary infiltrates






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