Study of Ventilator Associated Tracheobronchitis (VAT) in Respiratory Intensive Care Unit Patients and the impact of Aerosolized Antibiotics on their Outcome

Abstract

The aim of the current study was to assess VAT and to study the effect of aerosolized antibiotics (ceftazidime and amikacin) as an adjuvant therapy to systemic antibiotics on outcome of these patients during the course of eighteen months started from December 2013, in respiratory intensive care unit (RICU) Ain Shams University Hospital. The present study included 104 mechanically ventilated patients of different ages and gender. Thirty patients out of 104 were excluded from the start of the study due to presence of infection as a cause of admission. Seventy four patients were subjected to mini-BAL sampling of the lower respiratory tract secretions (thirty nine patients out of 74 were subjected to mini-BAL sampling once and did not continue the serial survey).Thirty five patients out of 74 were subjected to serial mini-BAL samples of the lower respiratory tract secretions, quantitative culture, and drug sensitivity twice a week. Two patients out of 35 patients showed no growth of any bacteria till extubation and 33 patients showed positive cultures. Twenty three patients out of 33 were diagnosed as VAT and 10 patients were diagnosed as early VAP. In the current study for diagnosis of VAT we used both clinical criteria (temperature >380 C or <360 C, Leukocytosis > 12,000 /mm3 and Sputum production; increase amount and change color to yellow, greenish or pus) and microbiological criteria (positive culture obtained by mini-BAL catheter with colony count <103 as cut off value for positive culture suggesting VAT) following the criteria recommended by Horan et al., (2008) and Craven et al., (2011). For diagnosis of VAP we used the same criteria for diagnosis of VAT with the development of CXR shadows suggesting pneumonia, which equal to CPIS score > 6 and we used 103 as cut off value of colony count for VAP following. Patients diagnosed as VAT were 23 patients out of 104 mechanically ventilated patients with incidence 22.1%. The mean age ± SD in this study was (55.2 ± 19.11) years old. 43. 47% of them were males and 56.52% were females and the causes of admission were chronic obstructive airway disease (COPD) and interstitial lung disease (ILD) 30.43% for each. Obese hypoventilation and obstructive sleep apnea, bronchogenic carcinoma, 8.6% for each, bronchial asthma, mesothelioma with pleural effusion, post-mechanical ventilation tracheal stenosis, post- operative and drug toxicity ARDS 4.3% for each of them. The most common co-morbidities were renal impairment and hypertension(26%) for each followed by diabetes mellitus (21.7%), cardiac diseases, cerebrovascular accidents and chronic liver diseases (13%) for each of them. The incidence of VAT was found to be 22.1%. During stage 2 of the study 33 patients showing positive cultures were classified into 3 groups. Group I: diagnosed as VAT received systemic antibiotics and aerosolized antibiotic: 13 patients (three of them did not continue receiving AA).Group II: diagnosed as VAT received only systemi