Urgent orotracheal intubation induces transient bacteremia in critically ill patients

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Objectives

To test the hypothesis that urgent or semi-urgent orotracheal intubation can induce short-lived bacteremia with oral flora. To find predictive factors for post-intubation bacteremia.

Methods

Prospective study in a 17 bed medical ICU. Patients in need of orotracheal intubation (OI) could be included if no cardiopulmonary resuscitation was performed. One aerobe and anaerobe blood culture (BC) was taken immediately before OI, as soon as possible (preferable less than 10 min) after and 60 min after OI. If it was impossible to take a BC before intubation, patients could be included if both BCs after OI were taken. The indication for OI, ease of OI, experience of the doctor (<10,<100 or >100 OI previously) and the antibiotics used before OI were registered.

Results

During the study period (16 weeks) 70 patients underwent OI. Twenty-eight patients were included. Lack of inclusion was always due to the urgency of the situation, which caused delay in taking the first post-intubation BC. Four patients (4/28 or 14%) had streptococcal bacteremia immediately after OI (mean of 11 min, SD 2.5). No patient (0/28) had streptococcal bacteremia 60 min after OI (P= 0.03). Three of the four patients showed streptococcal bacteremia after OI had to be performed by a second doctor because of difficulties experienced during OI whereas this was the case in only 4/24 in the control group (P<0.001). Two of the four doctors intubating the four patients with subsequent streptococcal bacteremia had previous experience of fewer than 10 OIs. Four of 24 doctors in the control group had previous experience of less than 10 OIs (P=<0.001). In other terms, three of the seven patients (43%) that needed to be intubated by a second doctor due to difficulties during OIs showed transient streptococcal bacteremia.

Conclusion

Non-elective (urgent or semi-urgent) OI can cause transient bacteremia with Streptococcus species in a significant proportion of medical intensive care patients. The observed frequency of bacteremia is higher than previously reported after elective OI. The difficulty of OI might be a major predisposing factor.