Implications of the presence of yeasts in tracheobronchial secretions of critically ill intubated patients.

The presence of some microorganisms in the respiratory tract is a known risk factor for the infection of air passages; however, it is not clear whether this holds true for Candida spp. Thus, our objective was to determine the frequency of yeast colonization in the tracheobronchial secretions of critically ill intubated patients and to assess the presence of these yeasts in the infra-cuff region of the endotracheal tube (ET). Patients aged 18 years or older who had been using an endotracheal tube for 48 hours were recruited. Tracheal secretions were collected; after extubation, the ETs were cut into two fragments in the infra-cuff region. One of these fragments was placed in a solution containing antibiotics and sent to the lab for culture and identification of yeasts. The remaining fragment was fixed and subjected to scanning electron microscopy (SEM). In total, 20 patients with an average age of 73.3 years (± 13.1) participated in this study. These patients remained under endotracheal intubation and invasive mechanical ventilation for an average of 6.4 (± 1.8) and 13.5 days (± 15), respectively. Of these patients, 45 % showed respiratory tract colonization by yeasts of the Candida genus, with C. albicans being the most frequently isolated species (66.7 %). Moreover, in almost 90 % of these patients, blastoconidia of the same yeast were found in the infra-cuff portion of the ET, as evidenced by SEM, strongly fixed on the ET surface. Yeasts isolated from both the infra-cuff region and the tracheobronchial secretions were susceptible to amphotericin B and fluconazole. In conclusion, our results show that the frequency of colonization by yeasts of the Candida genus in the tracheobronchial secretions of intubated patients within 48 hours is high, and that these species can also be found as a biofilm on the ET surface.

Prevalência de pneumonia associada à ventilação mecânica por meio de análise dassecreções traqueobrônquicas / Prevalence of ventilator-associated pneumonia through analysis of tracheobronchial secretions

Verificar a prevalência da pneumonia associada à ventilação mecânica por meio da coleta e análise das secreções traqueobrônquicas. Métodos: estudo observacional com 13 pacientes do sexo masculino. Foi aplicada a escala de Acute Physiology and Chronic Health Evalution e o Clinical Pulmonary Infection Score após 72horas de internação orotraqueal. Resultados: observou-se uma pontuação média de 33 pontos, ou seja, estes pacientes apresentaram em média 75% de chance de óbito. Foram encontradas como microorganismos de maiorprevalência o Staphylococcus aureus (23,07%) e Klebsiella pneumoniae (15,38%). Conclusão: a prevalência de pneumonia associada à ventilação mecânica foi de 25% dos casos e que o microorganismo de maior prevalência foi Klebsiella pneumoniae e Staphylococcus aureus.

Objective: to verify the prevalence of pneumonia associated with mechanical ventilation through the collectionand analysis of tracheobronchial secretions. Methods: an observational study with 13 male patients. The scaleof Acute Physiology and Chronic Health Evaluation and the Clinical Pulmonary Infection Score were appliedafter 72 hours of orotracheal hospitalization. Results: an average score of 33 points was observed, that is,these patients presented on average a 75% chance of death. Staphylococcus aureus (23.07%) and Klebsiellapneumoniae (15.38%) were found as the most prevalent microorganisms. Conclusion: the prevalence ofventilator-associated pneumonia was 25% of the cases and the most prevalent microorganisms were Klebsiellapneumoniae and Staphylococcus aureus.