Diagnosis of ventilator-associated pneumonia

Medford, Andrew R L; Husain, Syed Arshad; Turki, Hesham M.; Millar, Ann

doi:10.1016/j.jcrc.2008.06.012

Cited by 21 publications

(21 citation statements)

References 26 publications

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“…Yet, a consensus on both the clinical definition and final diagnosis of VAP are still lacking (5,6). Cultures of lower respiratory tract samples, such as protected specimen brush, bronchoalveolar lavage (BAL) fluid, or open-lung biopsy, have demonstrated high predictive value for the identification of VAP causative microorganisms and are frequently considered superior to endotracheal aspirates (ETAs) (7)(8)(9)(10)(11)(12). In contrast, an ETA sample is more readily obtainable from mechanically ventilated patients and is frequently a component of microbiological surveillance (13).…”

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confidence: 99%

“…ETA nonquantitative cultures nevertheless lack a validated threshold for positivity and, consequently, they may not distinguish colonization from infection and may be nonindicative for VAP. Furthermore, their value in VAP management has been explored only in small and experimental studies, and their usefulness remains under debate (7,13,15). Whereas only a few guidelines discourage the use of ETAs for VAP diagnosis (16), the majority of VAP guidelines recommend the use of either ETA or bronchoalveolar lavage fluid (BALF) analysis to diagnose VAP (17)(18)(19).…”

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confidence: 99%

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Endotracheal Aspirate and Bronchoalveolar Lavage Fluid Analysis: Interchangeable Diagnostic Modalities in Suspected Ventilator-Associated Pneumonia?

et al. 2014

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Authoritative guidelines state that the diagnosis of ventilator-associated pneumonia (VAP) can be established using either endotracheal aspirate (ETA) or bronchoalveolar lavage fluid (BALF) analysis, thereby suggesting that their results are considered to be in accordance. Therefore, the results of ETA Gram staining and semiquantitative cultures were compared to the results from a paired ETA-BALF analysis. Different thresholds for the positivity of ETAs were assessed. This was a prospective study of all patients who underwent bronchoalveolar lavage for suspected VAP in a 27-bed university intensive care unit during an 8-year period. VAP was diagnosed when >2% of the BALF cells contained intracellular organisms and/or when BALF quantitative culture revealed >104 CFU/ml of potentially pathogenic microorganisms. ETA Gram staining and semiquantitative cultures were compared to the results from paired BALF analysis by Cohen's kappa coefficients. VAP was suspected in 311 patients and diagnosed in 122 (39%) patients. In 288 (93%) patients, the results from the ETA analysis were available for comparison. Depending on the threshold used and the diagnostic modality, VAP incidences varied from 15% to 68%. For the diagnosis of VAP, the most accurate threshold for positivity of ETA semiquantitative cultures was moderate or heavy growth, whereas the optimal threshold for BALF Gram staining was >1 microorganisms per high power field. The Cohen's kappa coefficients were 0.22, 0.31, and 0.60 for ETA and paired BALF Gram stains, cultures, and BALF Gram stains, respectively. Since the ETA and BALF Gram stains and cultures agreed only fairly, they are probably not interchangeable for diagnosing VAP.

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Endotracheal Aspirate and Bronchoalveolar Lavage Fluid Analysis: Interchangeable Diagnostic Modalities in Suspected Ventilator-Associated Pneumonia?

et al. 2014

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“…Estudios como el de Ruiz y cols 14 o el de Sánchez-Nieto y cols 15 sugieren que el rendimiento diagnóstico entre el CCAT y técnicas más invasivas pudiese ser equivalente en cuanto a pronóstico. Otros estudios, más recientes, sugieren que el CCAT tiene menor capacidad diagnóstica respecto de métodos más invasivos y que estos últimos se asocian más frecuentemente a cambios en el esquema antibiótico, principalmente a des-escalamiento 12,16 . En particular, un estudio francés multicéntrico que reúne el mayor número de pacientes con sospecha de NAVM (n = 413) muestra que una estrategia invasora se asocia a disminución de la mortalidad a 14 días, menor disfunción de órganos y menor uso de antibióticos 12 .…”

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Resultados preliminares y factibilidad del mini lavado bronco-alveolar en pacientes cursando falla respiratoria severa

et al. 2011

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“…Priorinstitution of antibiotic therapy and upper airway colonization further complicates the microbial analysis (Mozzamil Shafi et al, (2015)). Cultures of lower respiratory tract samples, such as protected specimen brush, Bronchoalveolar lavage fluid or Open lung biopsy, have demonstrated high predictive value for the identification of VAP causative microorganisms and are frequently considered superior to endotracheal aspirates (Medford et al, (2009);Baselski et al, (1993). In contrast ETA samples are more readily obtainable from mechanically ventilated (MV) patients and is frequently a component of microbiogical surveillance (Brusselaers et al, (2013)).…”

Section: Introductionmentioning

confidence: 99%

“…Since colonization precedes infection, bacteria identified by cultures of ETA'S may indeed be the causative microorganisms. once VAP develops (Bontenet et al, (1996) ETA nonquantitative cultures nevertheless lack a validated threshold for positivity and, consequently they may not distinguish colonization from infection and may be non indicative for VAP (Medford et al, (2009), Brusselaers et al, (2013, Berton et al,). Only a few guidelines discourage the use of ETA's for VAP diagnosis (Masterton et al, 2008) …”

Section: Introductionmentioning

confidence: 99%

Spectrum of Organisms and Correlation of Gram-Smear and Quantitative Cultures of Endotracheal Aspirates and Broncho Alveolar Lavage Fluid with Clinical Criteria for the Diagnosis of Ventilator Associated Pneumonia

Prudhivi¹,

Sekhar²,

Kindo³

et al. 2016

Int.J.Curr.Microbiol.App.Sci

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The purpose of this study was (1) To evaluate the value of Gram stained smear (GSS) and quantitative cultures ofendotracheal aspirates(QC ETA) and bronchoalveolar lavage fluid (QC BALF) by correlating it with clinical criteria(CC)for the diagnosis of ventilator associated pneumonia (VAP).(2) To correlate GSS with QETA and QBALF cultures for the same. A prospective study was conducted over a period of one year. Respiratory samples -ETA: 53, BAL:25 and blood culture (BC):35 were collected from 53 patients admitted to medical and surgical ICU's who were on mechanical ventilation (MV) for >48 hrs (2-10 days). All these patients had various underlying comorbid illness and all of them were receiving antibiotics prior to the admission to ICU. A diagnosis of VAP was made on the basis of clinical, radiological and microbiological criteria. Cohen's Kappa coefficient was used to quantify the level of agreement between the diagnostic tests. The sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) of GSS of ETA with CC was found to be 80%, 24.2%, 39%, 67%;the strength of agreement was fair and the GSS of BALF with CC was 41.67%, 23%, 33%, 30%; the strength of agreement was just by chance alone. From this we conclude that taking GSS study (ETA & BALF) alone into consideration is not a reliable indicator for the diagnosis of VAP. Therefore the initial management of patients with suspected VAP could be based on carefully studied GSS examination correlated with clinical criteria and vise versa. The sensitivity, Specificity, PPV and NPV of QETA cultures with clinical criteria was 90%, 21.2%, 40%, 77.8% respectively; the strength of agreement is considered to be fair and that of BALF cultures with CC were 58%, 23%, 41%, 37.5%; the strength of agreement was considered to be moderate. QETA cultures have shown greater sensitivity and NPV. Hence they are best interpreted by taking clinical criteria into consideration as well. QBALF cultures have shown low sensitivity and specificity; but a moderate strength of agreement when compared with clinical criteria. Greater sensitivity and specificity could probably have been obtained if the samples were collected from the lower bronchoscope segments. We conclude that when it is not feasible to do BAL, QETA cultures correlated with CC can reliabely be taken into consideration for the diagnosis of VAP. The sensitivity, specificity, PPV and NPV of GSS with QETA cultures was 86%, 66.67%, 92.6%, 50%, and that of QBALF cultures were 76.5%, 75%, 86.7% and 60%. The strength of agreement was moderate with cultures. Since GSS study of both cultures have considerably shown high sensitivity and specificity, the initial management of patients with suspected VAP could be based on GSS examination.

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Diagnosis of ventilator-associated pneumonia

Cited by 21 publications

References 26 publications

Endotracheal Aspirate and Bronchoalveolar Lavage Fluid Analysis: Interchangeable Diagnostic Modalities in Suspected Ventilator-Associated Pneumonia?

Endotracheal Aspirate and Bronchoalveolar Lavage Fluid Analysis: Interchangeable Diagnostic Modalities in Suspected Ventilator-Associated Pneumonia?

Resultados preliminares y factibilidad del mini lavado bronco-alveolar en pacientes cursando falla respiratoria severa

Spectrum of Organisms and Correlation of Gram-Smear and Quantitative Cultures of Endotracheal Aspirates and Broncho Alveolar Lavage Fluid with Clinical Criteria for the Diagnosis of Ventilator Associated Pneumonia

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