Diagnosis of ventilator-associated pneumonia: nonroutine tools for routine practice

Ewig, Santiago

doi:10.1183/09031936.96.09071339

Cited by 7 publications

(2 citation statements)

References 33 publications

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“…Many surveillance lavages (64 %) taken from patients without pneumonia and in the absence of antibiotics, yielded a VAP pathogen at > 10 4 CFU/ml, mostly at > 10 days mechanical ventilation. This increase in bacterial load colonising the lung with duration of ventilation is well documented [29] and affects the diagnostic value of quantitative culture if a fixed threshold is adopted [4,30]. For specimens taken at 7 days or more of mechanical ventilation, raising the diagnostic threshold from 10 4 to 10 6 CFU/ml increased specificity markedly from 40 % to 73 % with little change in sensitivity.…”

Section: Discussionmentioning

confidence: 99%

The diagnosis of ventilator-associated pneumonia using non-bronchoscopic, non-directed lung lavages

Flanagan¹,

Findlay

Magee

et al. 2000

Intensive Care Med

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NBL is a simple, safe, cheap, readily-available method of diagnosing ventilator-associated pneumonia with comparable diagnostic accuracy to bronchoscopic techniques. Quantitation of respiratory tract cultures can exclude pneumonia in patients with equivocal clinical signs. The diagnostic threshold should vary depending on the length of ventilation, likelihood of pneumonia and antibiotic administration. The Bacterial Index is a flawed mathematical device that has no contributory role in pneumonia diagnosis. The CPIS has some diagnostic role in selected cohorts of ventilated patients.

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Section: Discussionmentioning

confidence: 99%

The diagnosis of ventilator-associated pneumonia using non-bronchoscopic, non-directed lung lavages

Flanagan¹,

Findlay

Magee

et al. 2000

Intensive Care Med

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“…Conversely, a BAL fluid colony count below the 10 4 -CFU/ml threshold points to oropharyngeal contamination. This theoretical concept has been validated in numerous clinical studies, and quantitative culture of BAL fluid specimens is consequently recommended as the reference method for the diagnosis of VAP (6).…”

mentioning

confidence: 99%

Accuracy and Precision of Quantitative Calibrated Loops in Transfer of Bronchoalveolar Lavage Fluid

Jacobs¹,

Brauwer²,

Cornelissen³

et al. 2000

J. Clin. Microbiol.

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Quantitative cultures of bronchoalveolar lavage (BAL) fluid are important in the diagnosis of ventilatorassociated pneumonia, and calibrated loops are commonly used to set up these cultures. In this study, the performances of calibrated 0.010-and 0.001-ml loops in the transfer of BAL fluid were determined. Five loops of one lot from seven manufacturers were tested. Calibrations were performed by the gravimetric method (0.010-ml loops) and the colorimetric method (0.001-ml loops). Most of the 0.010-ml loops displayed a precision that was less than 10%, but six of them showed very poor accuracies as they transferred a deficiency (nichrome loops) or an excess (disposable loops) of BAL fluid that exceeded ؎10%. The mean maximum and minimum BAL fluid volumes delivered by the 0.010-ml loops differed by a factor 3. The 0.001-ml loops displayed acceptable precision. Five of them showed inaccuracies of <؎10%, and mean maximum and minimum BAL fluid volumes had a range of a factor of 2. For all loops, the volumes of BAL fluid sampled were larger than the volumes of reagent-grade water sampled. Results of the colony counting experiments confirmed these findings and revealed a high intra-assay variability for the 0.001-ml loops. We conclude that, when BAL fluid samples are cultured with calibrated loops, (i) proper verification of the calibration of these loops is mandatory, (ii) calibrations should be performed with BAL fluid as the test solution, and (iii) borderline quantitative culture results should be interpreted with knowledge of the inaccuracy values of these loops.

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Quantitative Kulturen in der Pneumoniediagnostik — eine Methode für die Routine?

Ewig

Marklein²,

Nachtsheim³

et al. 1998

Med Klin

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Quantitative cultures of respiratory secretions represent a valid technique for the diagnosis of ventilator-associated pneumonia. Contamination, colonization and true infection can be differentiated with a reasonable specificity using established cut-offs of bacterial colony counts. Quantitative investigations provide local epidemiological databases as a framework for empirical antimicrobial policies and may also prove helpful in the guidance of individual antimicrobial therapy. Another reasonable indication is HIV-associated pneumonia. However, the use of this technique in routine practice is hampered by the high expertise and experience that will be necessary to be successfully used. Nevertheless, in view of the need to identify bacterial susceptibility patterns, at least large treatment centers should routinely use this most powerful diagnostic technique.

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Diagnosis of ventilator-associated pneumonia: nonroutine tools for routine practice

Cited by 7 publications

References 33 publications

The diagnosis of ventilator-associated pneumonia using non-bronchoscopic, non-directed lung lavages

The diagnosis of ventilator-associated pneumonia using non-bronchoscopic, non-directed lung lavages

Accuracy and Precision of Quantitative Calibrated Loops in Transfer of Bronchoalveolar Lavage Fluid

Quantitative Kulturen in der Pneumoniediagnostik — eine Methode für die Routine?

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