The course of nosocomial oropharyngeal colonization in patients recovering from acute respiratory failure.

We sought to determine the duration of nosocomially acquired Gram-negative bacilli (GNB) oropharyngeal colonization following hospitalization for acute respiratory failure (ARF). We selected 24 inpatients recovering from ARF who had positive oropharyngeal cultures for GNB. Follow-up cultures were obtained at the time of hospital discharge, and 2 and 4 weeks afterwards. The prevalence of GNB colonization in these patients was 14/21 (67 percent) at the time of hospital discharge and 14/23 (60 percent) 2 weeks afterwards. Both rates were greater than the control population's 7/30 (23 percent, p < 0.02 and < 0.05, respectively). Four weeks after hospital discharge, the prevalence of colonization had fallen to 7/19 (37 percent) which was not significantly different from that of controls. Five of 24 subjects were rehospitalized during the follow-up period. Pneumonia was diagnosed in only two of the five and both proved to be due to pathogens other than GNB. We conclude that the prevalence of GNB oropharyngeal colonization following ARF approaches control levels within four weeks of hospital discharge. We speculate that a post-ARF patient's risk for GNB pneumonia similarly declines.