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a Department of Internal
Medicine, University Hospital Maastricht, Maastricht, The Netherlands, b Department of Internal Medicine,
University Hospital Utrecht, Utrecht, The Netherlands, c Department of Medical Microbiology, University Hospital
Maastricht, Maastricht, The Netherlands, d Department of Internal Medicine,
Eemland Hospital, Amersfoort, The Netherlands
Correspondence to: Dr D C J J Bergmans, Department of Internal Medicine, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
Received 9 February 1998; Returned to authors 18 May 1998; Revised version received 17 June 1998; Accepted for publication 6 July 1998
BACKGROUND
Ventilator-associated
pneumonia (VAP) caused by Pseudomonas aeruginosa is
usually preceded by colonisation of the respiratory tract. During
outbreaks, colonisation with P aeruginosa is mainly derived from exogenous sources. The relative importance of different pathways of colonisation of P aeruginosa has rarely been
determined in non-epidemic settings.
METHODSIn order to determine the
importance of exogenous colonisation, all isolates of P
aeruginosa obtained by surveillance and clinical cultures from
two identical intensive care units (ICUs) were genotyped with pulsed
field gel electrophoresis.
RESULTSA total of 100 patients were
studied, 44 in ICU 1 and 56 in ICU 2. Twenty three patients were
colonised with P aeruginosa, seven at the start of the
study or on admission and 16 of the remaining 93 patients became
colonised during the study. Eight patients developed VAP due to P
aeruginosa. The incidence of respiratory tract colonisation and
VAP with P aeruginosa in our ICU was similar to that
before and after the study period, and therefore represents an endemic
situation. Genotyping of 118 isolates yielded 11 strain types: eight in
one patient each, two in three patients each, and one type in eight
patients. Based on chronological evaluation and genotypical identity of
isolates, eight cases of cross-colonisation were identified. Eight
(50%) of 16 episodes of acquired colonisation and two (25%) of eight
cases of VAP due to P aeruginosa seemed to be the result
of cross-colonisation.
CONCLUSIONSEven in non-epidemic settings
cross-colonisation seems to play an important part in the epidemiology
of colonisation and infection with P aeruginosa.
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