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Assistant Clinical Professor, Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, CA
Associate Specialist, Cardiovascular Research Institute, School of Medicine, University of California, San Francisco
Professor and Chair, Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco
Anesthetist-in-Chief, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA
Reprints: Dr. Yang, Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, 521 Parnassus Ave., Room C-152, San Francisco, CA 94143, fax 415/476-6632, yangk{at}pharmacy.ucsf.edu
BACKGROUND: Inappropriate antibacterial treatment of ventilator-associated pneumonia (VAP) due to multidrug-resistant (MDR) pathogens is associated with increased mortality. Endotracheal aspirate (ETA) surveillance cultures potentially identify MDR pathogens, particularly MDR Pseudomonas aeruginosa, resulting in improved selection of therapy in patients who subsequently develop VAP.
OBJECTIVE: To investigate the role of ETA surveillance cultures in the identification of MDR P. aeruginosa in newly intubated adults who subsequently develop VAP.
METHODS: Daily ETA surveillance cultures for P. aeruginosa were collected in all adults newly intubated for 48 hours or more. Patients with preexisting lung disease or colonization or infection with P. aeruginosa were excluded. Risk factors and outcomes of patients newly colonized with MDR P. aeruginosa were assessed.
RESULTS: Seventy-five patients newly colonized with P.
aeruginosa were identified. Twenty (27%) of these patients were colonized
with a P. aeruginosa isolate that was MDR (resistant to 
3 classes
of antibiotics). Six patients were colonized by an isolate resistant to all
tested classes of antibiotics. Forty-five percent of patients colonized with
MDR P. aeruginosa subsequently developed VAP. Prior receipt of
fluoroquinolones was an independent predictor of colonization with MDR P.
aeruginosa (OR 11.82; 95% CI 2.10 to 66.46; p = 0.005).
CONCLUSIONS: Performance of routine surveillance cultures may aid in the early detection of MDR P. aeruginosa, improving the initiation of early and appropriate antibiotic therapy for patients who subsequently develop VAP.
Key Words: antibiotics, multidrug resistance, Pseudomonas aeruginosa, ventilator-associated pneumonia
Published Online, November 25, 2008. www.theannals.com, DOI 10.1345/aph.1L210
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