%0 Journal Article
%T Traqueobronquitis Asociada al Ventilador (TAV), Implicancias del Diagn¨®stico Cl¨ªnico y Microbiol¨®gico en una Cohorte de Pacientes en Ventilaci¨®n Mec¨¢nica
%A Mart¨ªnez
%A Gustavo
%A Lonegro
%A Gustavo
%A Ramundo
%A Fernanda
%A Rolando
%A Luj¨¢n
%A Sarqu¨ªs
%A Sergio
%A Sosa
%A Ariel
%A Famiglietti
%A Angela
%A Vay
%A Carlos A
%A Irraz¨¢bal
%A C¨¦lica
%A Capdevila
%A Abelardo
%A Luna
%A Carlos M
%J Revista americana de medicina respiratoria
%D 2012
%I Scientific Electronic Library Online
%X 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 inf¨ªltrate 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 (¡Ý 104 colony forming units - cfu/ml) for vap and a ceta positive culture (low count from ¡Ý 103 to < 106 cfu/ ml and high count ¡Ý 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 ¡Ý 106 cfu/ml), a vap episode happened during the following 3 days (12 with bal culture ¡Ý 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.
%U http://www.scielo.org.ar/scielo.php?script=sci_abstract&pid=S1852-236X2012000100004&lng=en&nrm=iso&tlng=en