Bronchoalveolar Lavage in the Diagnosis of Ventilator-Associated Pneumonia: To Quantitate or Not, That Is the Question

被引:0
作者
Riaz, Omer J. [1 ]
Malhotra, Ajai K. [1 ]
Aboutanos, Michel B. [1 ]
Duane, Therese M. [1 ]
Goldberg, Aaron E. [1 ]
Borchers, C. Todd [1 ]
Martin, Nancy R. [1 ]
Ivatury, Rao R. [1 ]
机构
[1] Virginia Commonwealth Univ, Med Coll Virginia, Dept Surg, Div Trauma Crit Care Emergency Gen Surg, Richmond, VA 23298 USA
关键词
NOSOCOMIAL PNEUMONIA; RISK-FACTORS; SUSCEPTIBILITY; REPEATABILITY; SURVEILLANCE; INFECTIONS; MANAGEMENT; THRESHOLD; HISTOLOGY; PATTERNS;
D O I
暂无
中图分类号
R61 [外科手术学];
学科分类号
摘要
Quantitative bronchoalveolar lavage (BAL) is used to diagnose ventilator-associated pneumonia (VAP). We prospectively compared semiquantitative (SQ) and quantitative (Qu) culture of BAL for VAP diagnosis. Ventilated patients suspected of VAP underwent bronchoscopic BAL. BAL fluid was examined by both Qu (colony-forming units [CFUs]/mL) and SQ culture (none, sparse, moderate, or heavy) and results were compared. VAP was defined as 10(5) CFU/mL or greater on Qu culture. Over 36 months, 319 BALs were performed. Sixty-three of 319 (20%) showed diagnostic growth by Qu culture identifying a total of 81 organisms causing VAP. All 63 specimens showed growth of some organism(s) on SQ culture with 79 of 81 causative organisms identified and two (Pseudomonas, one; Corynebacterium, one) not identified. The remaining 256 specimens did not meet the threshold for VAP by the Qu method. Among these, 79 did not show any growth on SQ culture. Among the 240 specimens showing some growth on SQ culture, a total of 384 organisms were identified. VAP rates in relation to strength of growth on SQ culture were: sparse, 10 of 140 (7%); moderate, 24 of 147 (16%); and heavy, 45 of 97 (46%). Sensitivity (Sn), specificity (Sp), positive (PPV), and negative (NPV) predictive values of SQ culture of BAL fluid for the diagnosis of VAP were 97, 21, 21, and 97 per cent, respectively. Nonquantitative culture of BAL fluid is fairly accurate in ruling out VAP (high Sn and NPV). It however has poor Sp and PPV and using this method will lead to unnecessary antimicrobial use with its attendant complications of toxicity, cost, and resistance.
引用
收藏
页码:297 / 303
页数:7
相关论文
共 50 条
[21]   Molecular detection of Candida spp. and Aspergillus fumigatus in bronchoalveolar lavage fluid of patients with ventilator-associated pneumonia [J].
Khorvash, Farzin ;
Abbasi, Saeed ;
Yaran, Majid ;
Abdi, Fateme ;
Ataei, Behrooz ;
Fereidooni, Farzaneh ;
Hoseini, Shervin Ghaffari ;
Ahmadi-Ahvaz, Nasrin ;
Parsazadeh, Malihe ;
Haghi, Fariba .
JOURNAL OF RESEARCH IN MEDICAL SCIENCES, 2014, 19 :S46-S50
[22]   Antibiotics for ventilator-associated pneumonia [J].
Arthur, Lauren E. ;
Kizor, Russell S. ;
Selim, Adrian G. ;
van Driel, Mieke L. ;
Seoane, Leonardo .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2016, (10)
[23]   Controversies in Ventilator-Associated Pneumonia [J].
Combes, Alain ;
Luyt, Charles-Edouard ;
Trouillet, Jean-Louis ;
Chastre, Jean .
SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE, 2010, 31 (01) :47-54
[24]   Biological markers and diagnosis of ventilator-associated pneumonia [J].
Fagon, Jean-Yves .
CRITICAL CARE, 2011, 15 (02)
[25]   Ventilator-associated pneumonia: an overview [J].
DiCocco, Jennifer M. ;
Croce, Martin A. .
EXPERT OPINION ON PHARMACOTHERAPY, 2009, 10 (09) :1461-1467
[26]   Ventilator-associated pneumonia: Problems with diagnosis and therapy [J].
Wiener-Kronish, Jeanine P. ;
Dorr, Henry Isaiah .
BEST PRACTICE & RESEARCH-CLINICAL ANAESTHESIOLOGY, 2008, 22 (03) :437-449
[27]   Ventilator-Associated Events: Prevalence, Outcome, and Relationship With Ventilator-Associated Pneumonia [J].
Bouadma, Lila ;
Sonneville, Romain ;
Garrouste-Orgeas, Maite ;
Darmon, Michael ;
Souweine, Bertrand ;
Voiriot, Guillaume ;
Kallel, Hatem ;
Schwebel, Carole ;
Goldgran-Toledano, Dany ;
Dumenil, Anne-Sylvie ;
Argaud, Laurent ;
Ruckly, Stephane ;
Jamali, Samir ;
Planquette, Benjamin ;
Adrie, Christophe ;
Lucet, Jean-Christophe ;
Azoulay, Elie ;
Timsit, Jean-Francois .
CRITICAL CARE MEDICINE, 2015, 43 (09) :1798-1806
[28]   Prevention of ventilator-associated pneumonia [J].
Lau, Arthur C. W. ;
So, H. M. ;
Tang, S. L. ;
Yeung, Alwin ;
Lam, S. M. ;
Yan, W. W. .
HONG KONG MEDICAL JOURNAL, 2015, 21 (01) :61-68
[29]   Diagnosis of Bacterial Ventilator-Associated Pneumonia in Children: Reproducibility of Blind Bronchial Sampling [J].
Sachdev, Anil ;
Chugh, Krishan ;
Raghunathan, Veena ;
Gupta, Dhiren ;
Wattal, Chand ;
Menon, Geetha R. .
PEDIATRIC CRITICAL CARE MEDICINE, 2013, 14 (01) :E1-E7
[30]   2024 Year in Review: Ventilator-Associated Pneumonia [J].
Ring, Brian J. .
RESPIRATORY CARE, 2025,