Analysis of condensate contamination in pipelines of severe pneumonia patients undergoing mechanical ventilation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 MENG Zhaoquan , ZHANG Chaogui , WANG Guilin

Department of Emergency, Second People’s Hospital of Yibin City, Yibin, Sichuan 644000, P. R. China;

Corresponding?author：

MENG Zhaoquan, Email: 344453739@qq.com

Keywords：

Mechanical ventilation; Severe pneumonia; Condensate; Bacteria; Drug resistance

DOI：

10.7507/1671-6205.201910045

Video：

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Objective To investigate the condensate pollution in the pipeline of severe pneumonia patients undergoing mechanical ventilation.Methods From January 2017 to January 2019, 120 patients with severe pneumonia treated by mechanical ventilation in our hospital were collected continuously. The lower respiratory tract secretions were collected for bacteriological examination. At the same time, the condensed water in the ventilator exhaust pipe was collected for bacteriological examination at 4, 8, 12, 16, 20 and 24 hours after tracheal intubation and mechanical ventilation. The bacterial contamination in the condensed water at different time points was analyzed and separated from the lower respiratory tract. The consistency of bacteria in secretion and drug resistance analysis of bacterial contamination in condensate water were carried out.Results Of the 120 patients with severe pneumonia after mechanical ventilation, isolates were cultured in the lower respiratory tract secretions of 102 patients. One strain was cultured in 88 cases, two strains were cultured in 10 cases, and three strains were cultured in 4 cases. The isolates were mainly Gram-negative bacteria (57.5%) and Gram-positive bacteria (42.5%). The most common isolates were Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter baumannii. The contamination rate of condensate water was 5.0% at 4 hours, 37.5% at 8 hours, 60.0% at 12 hours, 76.7% at 16 hours, 95.0% at 20 hours, and 100.0% at 24 hours, respectively. The bacterial contamination rate in condensate water at different time points was statistically significant (P=0.000). The pollution rate at 4 hours was significantly lower than that at 8 hours (P=0.000). Gram-negative bacteria accounted for 57.5% and Gram-positive bacteria accounted for 42.5%. The most common isolates were Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii. The consistency of bacteria in lower respiratory tract and condensate water was 83.3% in severe pneumonia patients undergoing mechanical ventilation. The overall resistance of Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus was higher, but the resistance to imipenem/cilastatin was lower.Conclusions The bacterial contamination in the condensate of patients with severe pneumonia during mechanical ventilation is serious. The pollution rate is low within 4 hours. It is consistent with the bacterial contamination in lower respiratory tract and the bacterial resistance is high.

Citation： MENG Zhaoquan, ZHANG Chaogui, WANG Guilin. Analysis of condensate contamination in pipelines of severe pneumonia patients undergoing mechanical ventilation. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(6): 582-585. doi: 10.7507/1671-6205.201910045 Copy

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3.	Quah J, Jiang B, Tan PC, et al. Impact of microbial aetiology on mortality in severe community-acquired pneumonia. BMC Infect Dis, 2018, 18(1): 451-455.
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13.	閆衛彬, 盧立國, 孫婷婷, 等. 呼吸機相關性肺炎患者呼吸機管道冷凝液培養的臨床研究. 現代中西醫結合雜志, 2013, 22(8): 869-871.
14.	譚杏飛, 陳瀚熙, 藍惠蘭, 等. 密閉式呼吸機濕化管道系統細菌培養分析. 護理學雜志, 2015, 30(15): 92-94.
15.	劉亞楠. 呼吸機管道中冷凝水被污染時段及影響因素分析[D]. 錦州醫科大學, 2016.
16.	李娟, 田鵬, 張雪霜. 兒童呼吸機相關性肺炎與呼吸機管路細菌定植的關系. 臨床肺科雜志, 2018, 23(1): 104-106, 110.
17.	Zhao D, Zuo Y, Wang Z, et al. Characterize carbapenem-resistant Klebsiella pneumoniae isolates for nosocomial pneumonia and their Gram-negative bacteria neighbors in the respiratory tract. Mol Biol Rep, 2019, 12(3): 8984-8988.
18.	Watkins RR, Van Duin D. Current trends in the treatment of pneumonia due to multidrug-resistant Gram-negative bacteria. F1000Res, 2019, 8(2): 884-889.
19.	Feng DY, Zhou YQ, Zou XL, et al. Factors influencing mortality in hospital-acquired pneumonia caused by Gram-negative bacteria in China. J Infect Public Health, 2019, 12(12): 7843-7851.
20.	Cilloniz C, Dominedo C, Torres A. Multidrug resistant Gram-negative bacteria in community-acquired pneumonia. Crit Care, 2019, 23(1): 79-87.
21.	Le HN, Quetz JS, Tran VG, et al. MEDI3902 correlates of protection against severe Pseudomonas aeruginosa pneumonia in a rabbit acute pneumonia model. Antimicrob Agents Chemother, 2018, 62(5): 8944-8949.
22.	Su IC, Lee KL, Liu HY, et al. Severe community-acquired pneumonia due to Pseudomonas aeruginosa coinfection in an influenza A(H1N1) pdm09 patient. J Microbiol Immunol Infect, 2018, 12(20): 8748-8753.
23.	Serota DP, Sexton ME, Kraft CS, et al. Severe community-acquired pneumonia due to Acinetobacter baumannii in north America: case report and review of the literature. Open Forum Infect Dis, 2018, 5(3): 44-51.
24.	Iwasawa Y, Hosokawa N, Harada M, et al. Severe community-acquired pneumonia caused by Acinetobacter baumannii successfully treated with the initial administration of meropenem based on the sputum Gram staining findings. Intern Med, 2019, 58(2): 301-305.

1. Jia L, Zhao J, Yang C, et al. Severe pneumonia caused by coinfection with influenza virus followed by methicillin-resistant Staphylococcus aureus induces higher mortality in mice. Front Immunol, 2018, 9(2): 3189-3195.
2. Casas-Aparicio GA, Leon-Rodriguez I, Hernandez-Zenteno RJ, et al. Aggressive fluid accumulation is associated with acute kidney injury and mortality in a cohort of patients with severe pneumonia caused by influenza A H1N1 virus. PLoS One, 2018, 13(2): 2592-2598.
3. Quah J, Jiang B, Tan PC, et al. Impact of microbial aetiology on mortality in severe community-acquired pneumonia. BMC Infect Dis, 2018, 18(1): 451-455.
4. John KG, John TJ, Taljaard JJ, et al. The outcome of severe varicella pneumonia with respiratory failure admitted to the intensive care unit for mechanical ventilation. Eur Respir J, 2018, 52(1): 6774-6779.
5. 朱明華, 畢艷華, 劉華, 等. 呼吸機管路內細菌污染與呼吸機相關性肺炎的相關性研究. 中華醫院感染學雜志, 2017, 27(10): 2233-2236.
6. 王帥, 安里占. 呼吸機相關性肺炎的感染途徑及病原菌分布調查分析. 中國醫學裝備, 2017, 14(1): 35-38.
7. Andre C. Kalil, Mark L. Metersky, et al Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis, 2016, 63(5): e61-e111.
8. 裴興華, 于海明, 吳艷紅, 等. APACHEⅡ評分與老年重癥肺炎需有創機械通氣患者譫妄發生的關系. 中華危重病急救醫學, 2017, 29(9): 821-824.
9. Sakamoto Y, Yamauchi Y, Yasunaga H, et al. Guidelines-concordant empiric antimicrobial therapy and mortality in patients with severe community-acquired pneumonia requiring mechanical ventilation. Respir Investig, 2017, 55(1): 39-44.
10. Pleil JD, Wallace MAG. New breath related topics: sample collection for exhaled breath condensate and aerosol, development of real-time medical alerts, measurement of artificial atmospheres, and analysis of legalized cannabis product. J Breath Res, 2018, 12(3): 39001-39009.
11. Winters BR, Pleil JD, Angrish MM, et al. Standardization of the collection of exhaled breath condensate and exhaled breath aerosol using a feedback regulated sampling device. J Breath Res, 2017, 11(4): 107-112.
12. 邱淑花, 黃毓東, 劉云閣, 等. 呼吸機管路內細菌污染與呼吸機相關性肺炎的相關性. 深圳中西醫結合雜志, 2017, 27(21): 21-22.
13. 閆衛彬, 盧立國, 孫婷婷, 等. 呼吸機相關性肺炎患者呼吸機管道冷凝液培養的臨床研究. 現代中西醫結合雜志, 2013, 22(8): 869-871.
14. 譚杏飛, 陳瀚熙, 藍惠蘭, 等. 密閉式呼吸機濕化管道系統細菌培養分析. 護理學雜志, 2015, 30(15): 92-94.
15. 劉亞楠. 呼吸機管道中冷凝水被污染時段及影響因素分析[D]. 錦州醫科大學, 2016.
16. 李娟, 田鵬, 張雪霜. 兒童呼吸機相關性肺炎與呼吸機管路細菌定植的關系. 臨床肺科雜志, 2018, 23(1): 104-106, 110.
17. Zhao D, Zuo Y, Wang Z, et al. Characterize carbapenem-resistant Klebsiella pneumoniae isolates for nosocomial pneumonia and their Gram-negative bacteria neighbors in the respiratory tract. Mol Biol Rep, 2019, 12(3): 8984-8988.
18. Watkins RR, Van Duin D. Current trends in the treatment of pneumonia due to multidrug-resistant Gram-negative bacteria. F1000Res, 2019, 8(2): 884-889.
19. Feng DY, Zhou YQ, Zou XL, et al. Factors influencing mortality in hospital-acquired pneumonia caused by Gram-negative bacteria in China. J Infect Public Health, 2019, 12(12): 7843-7851.
20. Cilloniz C, Dominedo C, Torres A. Multidrug resistant Gram-negative bacteria in community-acquired pneumonia. Crit Care, 2019, 23(1): 79-87.
21. Le HN, Quetz JS, Tran VG, et al. MEDI3902 correlates of protection against severe Pseudomonas aeruginosa pneumonia in a rabbit acute pneumonia model. Antimicrob Agents Chemother, 2018, 62(5): 8944-8949.
22. Su IC, Lee KL, Liu HY, et al. Severe community-acquired pneumonia due to Pseudomonas aeruginosa coinfection in an influenza A(H1N1) pdm09 patient. J Microbiol Immunol Infect, 2018, 12(20): 8748-8753.
23. Serota DP, Sexton ME, Kraft CS, et al. Severe community-acquired pneumonia due to Acinetobacter baumannii in north America: case report and review of the literature. Open Forum Infect Dis, 2018, 5(3): 44-51.
24. Iwasawa Y, Hosokawa N, Harada M, et al. Severe community-acquired pneumonia caused by Acinetobacter baumannii successfully treated with the initial administration of meropenem based on the sputum Gram staining findings. Intern Med, 2019, 58(2): 301-305.

Chinese Journal of Respiratory and Critical Care Medicine

Analysis of condensate contamination in pipelines of severe pneumonia patients undergoing mechanical ventilation

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