Bacterial colonization profile in endo-tracheally intubated patients in the intensive-care unit,Kenyatta National Hospital, and the rationale for antibiotic therapy

Citation:
Otieno D. Bacterial colonization profile in endo-tracheally intubated patients in the intensive-care unit,Kenyatta National Hospital, and the rationale for antibiotic therapy.; 1994.

Abstract:

A prospective study on the bacterial colonization profile
of the respiratory tract was carried out on fifty-six (56)
patients admitted to the Kenyatta National Hospital, Intensive-
Care unit, and intubated for at least two days. between
January 1992 and March 1993.
During this period, a total number of four hundred and
fifty-eight (458) patients were admitted to the Intensive-
Care Unit. Out of these 25.7% (118) fell within the study
criteria, but only 47.4% of the eligible patients were
actually studied. •
Twenty-nine (29) were male and twenty-seven (27) were
female. The male to female ratio was 1.07:1. The patients'
ages ranged from eight (8) months to eighty (80) years, with
a peak in the 11-20year and another in the 31-40 year age
groups.
There were eight (8) different species of organisms
isolated during the study, most of which were gram-negative
bacilli. The most frequently isolated organism was proteus
29.1% (30) and the least common was enterococcus 3.9% (4).
Out of the fifty-six (56) patients, the colonization
rate was 30.4% (17). trache9-bronch~t~s 33.9% (19), and
pneumonia 35.7% (20). The severity of infection was found to
depend on the severitj .of illness. Of the eleven (11)
patients without organ fail~re, none developed pneumonia,
while 27% (3) had colonization and 73% (8) had tracheo-
bronchitis. There was a total of thirteen (11) uatients with
organ failure invoJving two or more systems; 69.2~ of t~ese
(9) had pneumonia, 30.7~ (4) had tracheo-bronchitis ann none
had colonization.
The duration of intubation varied from ~ to 9~ days in
this study. There was no clear relationship he tween the
duration of intubation and the severity of respiratory
infection. Duration of intubation of less than thirty davs
was associated wit~ 25~ (4) cases of colonization. 100% (19)
of tracheo-bronchitis and 90~ (lA) of uneumonia. Intuhation
for thirty days or more was associated with 75~ (13) cases
of colonization. 10% (2) of pneumonia and no case of
tracheo-bronchitis.
Ceftazidime (Fortum) was found to he the most effective
of the antihiotics tested against the isolated organisms;
100% effective in five (5) out of the eight (8) species
isolated.
Patients with either colonization or tracheo-bronchitis
were found to have a favourable outcome without antibiotics.
Of the 36 patients with either colonization or tracheobronchitis,
83% (30) made good recovery on conservative
management: regular 'chest phvsiotherapy and tracheo-bronchial
suctioning. One developed septicaemia and died despite
antibiotics. The other five died from multiple complications.
Twenty (20) patients diagnosed to have pneumonia were
put on specific antibiotic therapy. Only 16.6% (6) recovered.

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