Sputum analysis is often performed in newly intubated patients in our Medical Intensive Care Unit (MICU). The clinical relevance of this initial sputum analysis and adjustment of antibiotics based on the results is not known.
Retrospective analysis of newly intubated patients admitted to the MICU of New York Hospital Queens from July 2008 to November 2008. Hospital records were reviewed for sputum culture and sensitivity, antibiotic adjustments, and in-hospital mortality.
Of 50 patients analyzed, 44 underwent sputum analysis within 24–48 hours of intubation. In 25 cases, there was no growth, or the presence of Candida (Clean). Gram-negative bacteria (GN) were found in 15 specimens. Staphylococcus aureus (SA) grew in 7 specimens. Antibiotics were changed according to sputum results in 32 of 44 patients, 21 with discontinuing of antibiotics, 5 with broadening, and 6 with substitutions. Of 32 patients with antibiotics changed, 8 died. Of 12 patients without antibiotics changed, 8 died. The mortality rate in the patient group with antibiotics changed according to sputum culture was significantly lower than in the group without appropriate antibiotic changes (25% vs. 67%,) [Table 1]. This trend was also found with analysis of organism, broken down into GN, SA, and Clean [Table 2]. However, upon subset analysis, those with both GN and SA had 100% mortality regardless of antibiotic change.
Although a small sample size, the results indicate that adjusting antibiotics according to initial sputum culture leads to a reduction in mortality. This trend was found even when analyzed by sputum result, except in 3 cases growing both GN and SA. In these three, there was 100% mortality regardless of the antibiotic change. This suggests that sputum growing both GN and SA holds a worse prognosis. However, further analysis in a larger study would be needed.
The data suggests that newly intubated patients who undergo adjustment of antibiotics based on initial sputum culture results appear to have reduced mortality.
Ruby Varghese, No Financial Disclosure Information; No Product/Research Disclosure Information