Seawater drowning-associated pneumonia: a 10-year descriptive cohort in intensive care unit
Abstract Background Pneumonia is one of the major complications of drowning, but the optimal empirical antibiotic treatment is not clearly defined. Multidrug-resistant (MDR) bacteria and fungi have been identified in a recent series of freshwater drowning-associated pneumonia. However, microbial dat...
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doaj-dbaf55d0b95346ea8ebcfd19f21188cc2020-11-24T21:19:21ZengSpringerOpenAnnals of Intensive Care2110-58202017-04-01711710.1186/s13613-017-0267-4Seawater drowning-associated pneumonia: a 10-year descriptive cohort in intensive care unitAlexandre Robert0Pierre-Éric Danin1Hervé Quintard2Nicolas Degand3Nihal Martis4Denis Doyen5Céline Pulcini6Raymond Ruimy7Carole Ichai8Gilles Bernardin9Jean Dellamonica10Service de Réanimation Médicale, Hôpital l’Archet 1Service de réanimation polyvalente, Hôpital l’Archet 2Service de réanimation polyvalente, Hôpital Pasteur 2Service de Microbiologie, Hôpital l’Archet 2Service de Médecine Interne, Hôpital l’Archet 1Service de Réanimation Médicale, Hôpital l’Archet 1CHRU de Nancy, Service de Maladies Infectieuses et Tropicales and Université de LorraineService de Microbiologie, Hôpital l’Archet 2Service de réanimation polyvalente, Hôpital Pasteur 2Service de Réanimation Médicale, Hôpital l’Archet 1Service de Réanimation Médicale, Hôpital l’Archet 1Abstract Background Pneumonia is one of the major complications of drowning, but the optimal empirical antibiotic treatment is not clearly defined. Multidrug-resistant (MDR) bacteria and fungi have been identified in a recent series of freshwater drowning-associated pneumonia. However, microbial data in seawater drowning are scarce. The objective of the study is to describe the microorganisms isolated in early respiratory specimens obtained from seawater drowning-associated pneumonia and to provide their antibiotic susceptibility pattern. Methods All patients admitted for seawater drowning between 2003 and 2013 to two intensive care units, from the region in France with the highest drowning rate, were retrospectively included. Demographics, antimicrobial therapy and microbiological data from respiratory samples collected within the first 48 h after admittance were analyzed. Results Seventy-four drowned patients were included, of which 36 (49%) were diagnosed by the clinician as having early pneumonia. Concerning the overall population, the median simplified acute physiology score (version 2) was 45 (30–65), and the mortality was 26%. Twenty-four respiratory samples from different patients were obtained within the first 48 h. Sixteen were positive. The main microorganisms found were Enterobacteriaceae (Enterobacter spp., Klebsiella spp. and Escherichia coli) and Gram-positive aerobic cocci (Streptococcus pneumonia and Staphylococcus aureus) with a low rate of antimicrobial resistance. No MDR bacteria or fungi were identified. However, among the positive respiratory samples collected, 5/16 (31%) grew bacteria with natural resistance to amoxicillin–clavulanate, the first-line antibiotic commonly used in our cohort. Resistance was only found among Gram-negative bacteria and from respiratory samples of patients with a higher drowning grade at admission (p = 0.01). Conclusions This 10-year descriptive study, the largest cohort to date, provides early respiratory samples from seawater drowning patients. The microorganisms retrieved were either mostly part of the human oro-pharyngeal flora or Enterobacteriaceae and displayed low rates of antimicrobial resistance. Respiratory samples should nonetheless be collected at admittance to the ICU to avoid inappropriate treatment. Empiric use of cephalosporin could be restricted to severe patients or if Gram-negative bacilli are found after direct examination.http://link.springer.com/article/10.1186/s13613-017-0267-4DrowningSeawaterPneumoniaAntibioticResistance |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Alexandre Robert Pierre-Éric Danin Hervé Quintard Nicolas Degand Nihal Martis Denis Doyen Céline Pulcini Raymond Ruimy Carole Ichai Gilles Bernardin Jean Dellamonica |
spellingShingle |
Alexandre Robert Pierre-Éric Danin Hervé Quintard Nicolas Degand Nihal Martis Denis Doyen Céline Pulcini Raymond Ruimy Carole Ichai Gilles Bernardin Jean Dellamonica Seawater drowning-associated pneumonia: a 10-year descriptive cohort in intensive care unit Annals of Intensive Care Drowning Seawater Pneumonia Antibiotic Resistance |
author_facet |
Alexandre Robert Pierre-Éric Danin Hervé Quintard Nicolas Degand Nihal Martis Denis Doyen Céline Pulcini Raymond Ruimy Carole Ichai Gilles Bernardin Jean Dellamonica |
author_sort |
Alexandre Robert |
title |
Seawater drowning-associated pneumonia: a 10-year descriptive cohort in intensive care unit |
title_short |
Seawater drowning-associated pneumonia: a 10-year descriptive cohort in intensive care unit |
title_full |
Seawater drowning-associated pneumonia: a 10-year descriptive cohort in intensive care unit |
title_fullStr |
Seawater drowning-associated pneumonia: a 10-year descriptive cohort in intensive care unit |
title_full_unstemmed |
Seawater drowning-associated pneumonia: a 10-year descriptive cohort in intensive care unit |
title_sort |
seawater drowning-associated pneumonia: a 10-year descriptive cohort in intensive care unit |
publisher |
SpringerOpen |
series |
Annals of Intensive Care |
issn |
2110-5820 |
publishDate |
2017-04-01 |
description |
Abstract Background Pneumonia is one of the major complications of drowning, but the optimal empirical antibiotic treatment is not clearly defined. Multidrug-resistant (MDR) bacteria and fungi have been identified in a recent series of freshwater drowning-associated pneumonia. However, microbial data in seawater drowning are scarce. The objective of the study is to describe the microorganisms isolated in early respiratory specimens obtained from seawater drowning-associated pneumonia and to provide their antibiotic susceptibility pattern. Methods All patients admitted for seawater drowning between 2003 and 2013 to two intensive care units, from the region in France with the highest drowning rate, were retrospectively included. Demographics, antimicrobial therapy and microbiological data from respiratory samples collected within the first 48 h after admittance were analyzed. Results Seventy-four drowned patients were included, of which 36 (49%) were diagnosed by the clinician as having early pneumonia. Concerning the overall population, the median simplified acute physiology score (version 2) was 45 (30–65), and the mortality was 26%. Twenty-four respiratory samples from different patients were obtained within the first 48 h. Sixteen were positive. The main microorganisms found were Enterobacteriaceae (Enterobacter spp., Klebsiella spp. and Escherichia coli) and Gram-positive aerobic cocci (Streptococcus pneumonia and Staphylococcus aureus) with a low rate of antimicrobial resistance. No MDR bacteria or fungi were identified. However, among the positive respiratory samples collected, 5/16 (31%) grew bacteria with natural resistance to amoxicillin–clavulanate, the first-line antibiotic commonly used in our cohort. Resistance was only found among Gram-negative bacteria and from respiratory samples of patients with a higher drowning grade at admission (p = 0.01). Conclusions This 10-year descriptive study, the largest cohort to date, provides early respiratory samples from seawater drowning patients. The microorganisms retrieved were either mostly part of the human oro-pharyngeal flora or Enterobacteriaceae and displayed low rates of antimicrobial resistance. Respiratory samples should nonetheless be collected at admittance to the ICU to avoid inappropriate treatment. Empiric use of cephalosporin could be restricted to severe patients or if Gram-negative bacilli are found after direct examination. |
topic |
Drowning Seawater Pneumonia Antibiotic Resistance |
url |
http://link.springer.com/article/10.1186/s13613-017-0267-4 |
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