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Revista americana de medicina respiratoria

On-line version ISSN 1852-236X


MARTINEZ, Gustavo et al. Ventilator Associated Tracheobronchitis (VAT), Implications of Clinical and Microbiological Diagnosis in a Cohort of Mecanical Ventilated Patients. Rev. amer. med. respiratoria [online]. 2012, vol.12, n.1, pp.10-16. ISSN 1852-236X.

The ventilator associated tracheobronchitis (VAT) is a process between airway colonization and ventilator-associated pneumonia (VAP). The antimicrobial therapy of VAT would reduce the incidence of VAP and its consequences. Methods: Daily follow up and twice a week routine quantitative culture of endotracheal aspirates (CETA) up to weaning were performed in 323 mechanically ventilated patients. When a lower respiratory tract infection was suspected (2/3 clinical criteria), if a new radiographic infíltrate was present, VAP was diagnosed and a bronchoalveolar lavage (BAL) culture was performed; if a radiographic infiltrate was absent, VAT was diagnosed. The bacteriological criteria for diagnosis were a BAL culture positive (≥ 104 colony forming units - cfu/ml) for VAP and a CETA positive culture (low count from ≥ 103 to < 106 cfu/ ml and high count ≥ 106 ufc/ml) for VAT. Results: In 443 of 2,309 radiographs an infiltrate was absent or was diffuse and stable; 92 of them met diagnostic clinical criteria for VAT. In 13 (12 with CETA culture ≥ 106 cfu/ml), a VAP episode happened during the following 3 days (12 with BAL culture ≥ 104 cfu/ml). In 11/15 (73.3%) VAP cases, the isolated pathogens were the same that had been present in the preceding VAT episode. On the other side, ten episodes of VAT were diagnosed during the 7 days after the VAP. Only 4/12 (33.3%) isolated pathogens were the same than those isolated in the VAT preceding the VAP, p=0.045. Seventy VATs had not any temporal relationship with episodes of VAP. Discusion: This study suggests that antimicrobial therapy could prevent a VAP in 14% of the TAV cases. Therefore, exposure to antibiotics was unnecessary in 86% of cases. This finding could represent a severe limitation to the recommendation of treating TAVs with antibiotics to prevent VAPs.

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