Skip to main content

Study of ventilator-associated tracheobronchitis in respiratory ICU patients and the impact of aerosolized antibiotics on their outcome

An Erratum to this article was published on 25 April 2017

This article has been updated

Abstract

Background

Lower respiratory tract infections in intubated patients include ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia. Aerosol delivery to intubated patients has improved with advances in techniques and with the development of newer aerosol generators.

Aim

The aim of the current study was to assess VAT and study the effect of aerosolized antibiotics (AAs) as an adjuvant to systemic antibiotic (SA) on outcome in VAT patients over 18 months, starting from December 2013, who were admitted to the respiratory ICU of Ain Shams University Hospital.

Patients and methods

Seventy-four patients out of 104 mechanically ventilated patients admitted to the respiratory ICU were subjected to serial mini-BAL sputum sampling from the first day of mechanical ventilation (MV). Thirty-two patients who developed VAT were divided into two groups: group I (13 VAT patients who received AAs in the form of ceftazidime 500 mg/12 h+amikacin 400 mg/12 h added to the SA) and group II (10 VAT patients who received only SA). The current study included only those patients whose relatives agreed to share in the study. All patients were subjected to daily assessment for signs of respiratory tract infection and to twice weekly chest radiography, leukocytic count evaluation, and microbiological assessment using mini-BAL.

Results

VAT incidence was found to be 22.1%. Eighty percent of patients who received AAs showed clinical improvement in the form of significant decrease in temperature, amount of sputum, and leukocytic count, and significant increase in PaO2/FiO2 ratio, in comparison with 30% in the SA group.

Conclusion

The incidence of VAT was found to be 22.1%, and was mainly caused by Gram-negative bacteria. AAs adjuvant to SA were effective in rapid resolution of signs of respiratory infection, in causing decreased bacterial load, reduced bacterial resistance, reduced progression of VAT to ventilator-associated pneumonia, reduced days of SA use, decreasedMVdays and ICU stay days, and probably reduced cost of ICU admission, but did not affect mortality.

Change history

  • 25 April 2017

    The “How to cite this article” section information is written incorrectly and should read as “Ahmed MM, Dayem AA, Gomaa AA, Ziada KW, Ali HM. Study of ventilator-associated tracheobronchitis in respiratory ICU patients and the impact of aerosolized antibiotics on their outcome.

References

  1. Leistner R, Kankura L, Bloch A, Sohr D, Gastmeier P, Geffers C. Attributable cost of ventilator-associated lower respiratory tract infection acquired on intensive care units: a retrospectively matched cohort study. Antimicrob Resist Infect Control 2013; 2:13.

    Article  Google Scholar 

  2. Dhand R, Sohal H. Pulmonary drug delivery systemfor inhalation therapy in mechanically ventilated patients. Expert Rev Med Devices 2008; 5:9–18.

    CAS  Article  Google Scholar 

  3. Dhand R. Bronchodilator therapy. In: Tobin M, editor. Principles and practice of mechanical ventilation. 2nd ed. New York: McGraw Hill 2006. 1277–1310

    Google Scholar 

  4. Abd-Elfatah N, Madkour A, Sharkawy S, Fahmy G. The efficiency of a new, cheap and safe method in a acquiring a mini-BAL sample for VAP diagnosis: an initial Egyptian trial. Chest 2009; 136:82–83.

    Article  Google Scholar 

  5. Dallas J, Skrpky L, Abebe N, BoyleWAIII, Kollef MH. Ventilator-associated tracheobronchitis in a mixed surgical and medical ICU population. Chest 2011; 139:513–518.

    Article  Google Scholar 

  6. Craven DE, Hudcova J, Lei Y. Diagnosis of ventilator-associated respiratory infections): microbiologic clues for tracheobronchitis (VAT) and pneumonia (VAP). Clin Chest Med 2011; 32:547–557.

    Article  Google Scholar 

  7. Lu Q, Yang J, Liu Z, Gutierrez C, Aymard G, Rouby JJ. Nebulized ceftazidime and amikacin in ventilator-associated pneumonia caused by Pseudomonas aeruginosa. Am J Respir Crit Care Med 2011; 184:106–115.

    CAS  Article  Google Scholar 

  8. Niederman MS, Chastre J, Corkery K, Marcantonio A, Fink JB, Luyt CE, Sanchez M. Inhaled amikacin reduces IV antibiotic use in intubated mechanically ventilated patients. Am J Respir Crit 2007; 11:97.

    Google Scholar 

  9. Grgurich PE, Hudcova J, Lei Y, Sarwar A, Craven DE. Diagnosis of ventilator-associated pneumonia: controversies and working toward a gold standard. Curr Opin Infect Dis 2013; 26:140–150.

    Article  Google Scholar 

  10. Agrafiotis M, Siempos II, Falagas ME. Frequency, prevention, outcome and treatment of ventilator-associated tracheobronchitis: systematic review and meta-analysis. Respir Med 2010; 104:325–336

    Article  Google Scholar 

  11. American Thoracic Society and Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilatorassociated, and health care associated pneumonia. Am J Respir Crit Care Med 2005; 171:388–416.

    Article  Google Scholar 

  12. Bregeon F, Papazian L, Visconti A. Diagnostic accuracy of protected catheter sampling in ventilator- associated bacterial pneumonia. Eur Respir J 2000; 5:969–975.

    Article  Google Scholar 

  13. Nseir S, Di Pompeo C, Pronnier P, Beague S, Onimus T, Saulnier F, Grandbastien B, Mathieu D, Delvallez-Roussel M, Durocher A. Nosocomial tracheobronchitis in mechanically ventilated patients: incidence, aetiology and outcome. Eur Respir J 2002; 20:1483–1489.

    CAS  Article  Google Scholar 

  14. Nseir S, Martin-Loeches I, Markris D, Jaillette E, Karvouniaris M, Valles J, et al. Impact of appropriate antimicrobial treatment on transition from ventilator-associated trachea-bronchitis to ventilator-associated pneumonia. Crit Care Med 2014; 18:129.

    Google Scholar 

  15. Palmer LB, Smaldone GC, Chen JJ, Baram D, Duan T, Monteforte M, et al. Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit. Crit Care Med 2008; 36:2008–2013.

    CAS  Article  Google Scholar 

  16. Craven DE, Lei Y, Ruthazer R, Sarwar A, Hudcova J. Incidence and outcome of ventilator- associated tracheobronchitis and pneumonia. Am J Med 2013; 126:542–549.

    Article  Google Scholar 

  17. Montgomery AB, Vallance S, Abuan T, Tservistas M, Davies A. A randomized double-blind placebo-controlled dose-escalation phase 1 study of aerosolized amikacin and fosfomycin delivered via the PARI investigational eFlow® inline nebulizer system in mechanically ventilated patients. J Aerosol Med Pulm Drug Deliv 2014; 2:441–448.

    Article  Google Scholar 

  18. Rodriguez A, Povoa P, Nseir S, Salluh J, Curcio D, Martin-Loeches I. Incidence and diagnosis of ventilator-associated tracheobronchitis in the intensive care unit: an international online survey, Crit Care 2014; 18: R32.

    Article  Google Scholar 

  19. Nseir S, Favory R, Jozefowicz E, Decamps F, Dewavrin F, Brunin G, et al. Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study. Crit Care 2008; 9:238–245.

    Article  Google Scholar 

  20. Nseir S, Ader F, Marquette CH. Nosocomial tracheobronchitis. Curr Opin Infect Dis 2009; 22:148–153.

    Article  Google Scholar 

  21. Martin-Loeches I, Nseir S, Valles J, Artigas A. From ventilator-associated tracheobronchitis to ventilator associated pneumonia. Reanimation 2013; 22:231–237.

    Article  Google Scholar 

  22. NiedermanMS, Chastre J, Corkery K, Fink JB, Luyt CE, GarciaMS. BAY41- 6551 achieves bactericidal tracheal aspirate amikacin concentrations in mechanically ventilated patients with Gram-negative pneumonia. Intensive Care Med 2012; 38:263–271.

    Article  Google Scholar 

  23. Ali M. Effect of nebulized antibiotics in treatment of ventilator associated pneumonia in El Abbasia Chest Hospital ICU [thesis for Master Degree]. Egypt: Ain Shams University Hospital; 2014.

    Google Scholar 

  24. Ghannam DE, Rodriguez DH, Raad II, Safdar A. Inhaled aminoglycosides in cancer patients with ventilator-associated Gram-negative bacterial pneumonia: safety and feasibility in the era of escalating drug resistance. Eur J Clin Microbiol Infect Dis 2009; 28:253–259.

    CAS  Article  Google Scholar 

  25. Lu Q, Luo R, Bodin L, Yang J, Zahr N, Aubry A, et al. Efficacy of high-dose nebulized colistin in ventilator-associated pneumonia caused by multidrugresistant Pseudomonas aeruginosa and Acinetobacter baumannii. Anesthesiology 2012; 117:1335–1347.

    CAS  Article  Google Scholar 

  26. Palmer LB, Smaldone GC. Reduction of bacterial resistance with inhaled antibiotics in the ICU. Am J Respir Crit Care Med 2014; 189:1225.

    Article  Google Scholar 

  27. Wood GC, Boucher BA, Croce MA, Hanes SD, Herring VL, Fabian TC. Aerosolized ceftazidime for prevention of ventilator-associated pneumonia and drug effects on the proinflammatory response in critically ill trauma patients. Pharmacotherapy 2002; 22:972–978.

    CAS  Article  Google Scholar 

  28. Ioannidou E, Siempos II, Falagas ME. Administration of antimicrobials via the respiratory tract for the treatment of patients with nosocomial pneumonia: a meta-analysis. JAntimicrobChemother 2007;60:1216–1226.

    CAS  Google Scholar 

  29. Doshi NM, Cook CH, Mount KL, Stanislaw P, Erin N, Heather A, et al. Adjunctive aerosolized colistin for multidrug resistant Gram-negative pneumonia in the critically ill: a retrospective study. BMC Anesthesiol 2013; 13:45.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hanaa Ali.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ali, H. Study of ventilator-associated tracheobronchitis in respiratory ICU patients and the impact of aerosolized antibiotics on their outcome. Egypt J Bronchol 10, 301–309 (2016). https://doi.org/10.4103/1687-8426.193628

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1687-8426.193628

Keywords

  • aerosolized antibiotics
  • mini-BAL
  • ventilator-associated tracheobronchitis