Bronchopulmonary superinfections in the critically ill.

Bacterial colonization of the airways can lead to nosocomial respiratory infections. The emergence of Gram-negative bacteria in the upper airways is usual in critical conditions. Antimicrobial therapy and especially bacterial adherence to the airways mucosa have been incriminated in the selection of Gram-negative bacteria becoming ultimately multiresistant. Transmission of bacteria by the hands of the ICU-personnel and aspiration of bacteria represent two important factors in the airway colonization. Bacterial clearance can simultaneously be impaired by debility and altered mental state. Pulmonary infections are especially common in peritonitis or after abdominal surgery. In a series of 30 patients who had a complicated course after abdominal surgery, we observed that in all patients with acute respiratory failure, sputum cultus yielded at least one microorganism also recovered from cultus of the abdominal secretions. Acute respiratory failure was most commonly due to respiratory infection and carried a worse prognosis. Aspiration of bacteria from the gastrointestinal tract appears to represent the most common source of nosocomial bronchopulmonary superinfection in the critically ill.