Diagnostic and therapeutic management of nosocomial pneumonia in surgical patients: Results of the Eole study

Montravers, Philippe; Veber, Benoît; Auboyer, C.; Dupont, Hervé; Gauzit, R.; Korinek, Anne Marie; Malledant, Yannick; Martin, Claude; Moine, Pierre; Pourriat, J.-L.

doi:10.1097/00003246-200202000-00017

Cited by 90 publications

(70 citation statements)

References 30 publications

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“…o diagnóstico de PAV neste estudo foi baseado em critérios clínicos recomendados pelo CDC, sem necessidade de confirmação por culturas. o diagnóstico baseado em resultados de culturas traz a vantagem de ter maior acurácia, porém aumenta a possibilidade de resultados falso-negativos, perdendo os casos com suspeita clínica não confirmada 13,16,17 . A ocorrência de resultados de culturas falso-positivos pode levar ao uso desnecessário de antibióticos, exercendo pressão para o surgimento de resistência bacteriana, portanto o diagnóstico deve-se basear em critérios clínicos além dos resultados microbiológicos.…”

Section: Discussionunclassified

Pneumonia associada à ventilação mecânica em Unidade de Terapia Intensiva cirúrgica

Carrilho¹,

Grion²,

Carvalho³

et al. 2006

Rev. bras. ter. intensiva

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Section: Discussionunclassified

Pneumonia associada à ventilação mecânica em Unidade de Terapia Intensiva cirúrgica

Carrilho¹,

Grion²,

Carvalho³

et al. 2006

Rev. bras. ter. intensiva

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“…Diagnostic strategies have been extensively studied in VAP and community-acquired pneumonia but not in non-ventilator ICU-acquired pneumonia. 2,4,5,21 The best method for collecting lower-respiratory-tract secretions remains unclear. The European Respiratory Society stated that "bronchoscopic sampling of the lower respiratory tract can be considered in selected non-intubated patients, where gas exchange status allows."…”

Section: Discussionmentioning

confidence: 99%

“…One group routinely performed FOB to obtain pulmonary samples, 21 whereas only 44% of EOLE study subjects underwent FOB. 4 The diagnostic usefulness of protected specimen brush sampling has been established in both intubated and non-intubated subjects. 3,9,14,17 This technique is both sensitive and specific for identifying microorganisms.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, Candida pneumonia is rare, and the recovery of Candida species from respiratory-tract secretions is usually not clinically important 23 but warrants further investigation. 3 In other studies, S. epidermidis was isolated from 1.4 -7.0% of cultures 3,4,17,24 and considered either nonpathogenic 24 or pathogenic. 25 The appropriateness of treatment in patients with S. epidermidis should be discussed on a caseby-case basis.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis and treatment of non-ventilator ICU-acquired pneumonia remain challenging. 2,4,5 Few studies have assessed the accuracy of clinical diagnostic methods. In particular, the Clinical Pulmonary Infection Score (CPIS) 6 based on clinical variables has been suggested for the diagnosis and management of VAP 6,7 but has not been evaluated in non-ventilator ICU-acquired pneumonia.…”

Section: Introductionmentioning

confidence: 99%

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Non-Ventilator ICU-Acquired Pneumonia After Cardiothoracic Surgery: Accuracy of Diagnostic Tools and Outcomes

et al. 2015

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BACKGROUND: Non-ventilator ICU-acquired pneumonia after cardiothoracic surgery is challenging to diagnose, and little is known about its impact on patient outcomes. Here, our primary objective was to compare the sensitivity and specificity of cultures of 2 types of fiberoptic bronchoscopy (FOB) specimens: endotracheal aspirates (FOB-EA) and bronchoalveolar lavage fluid (FOB-BAL). The secondary objectives were to evaluate the sensitivity and specificity of spontaneous sputum cultures and of the modified Clinical Pulmonary Infection Score (CPIS) and to describe patient outcomes. METHODS: We conducted a prospective observational study of consecutive cardiothoracic surgery subjects with suspected non-ventilator ICU-acquired pneumonia. Using FOB-BAL cultures >10 4 cfu/mL as the reference standard, we evaluated the accuracy of FOB-EA >10 5 cfu/mL and spontaneous sputum >10 7 cfu/mL. On the day of FOB, we determined the modified CPIS. Mortality and antibiotic treatments were recorded. RESULTS: Of 105 subjects, 57 (54.3%) received a diagnosis of non-ventilator ICU-acquired pneumonia. FOB-EA cultures had 82% (95% CI 69 -91%) sensitivity and 100% (95% CI 89 -100%) specificity and were significantly less sensitive than FOB-BAL cultures (P < .004). Spontaneous sputum was obtained from one-third of subjects. Spontaneous sputum cultures had 82% (95% CI 56 -95%) sensitivity and 94% (95% CI 68 -100%) specificity and were non-significantly less sensitive than FOB-BAL (P ‫؍‬ .061). A modified CPIS >6 had 42% (95% CI 29 -56%) sensitivity and 87% (95% CI 74 -95%) specificity for non-ventilator ICU-acquired pneumonia. Antibiotic therapy was stopped in all subjects without non-ventilator ICU-acquired pneumonia, after 1.6 ؎ 1.2 d, without deleterious effects. CONCLUSIONS: The modified CPIS has low diagnostic accuracy for non-ventilator ICU-acquired pneumonia. FOB-EA cultures perform less well than do FOB-BAL cultures for diagnosing nonventilator ICU-acquired pneumonia. Spontaneous sputum is valuable when FOB cannot be performed but could be obtained in only a minority of subjects. When cultures are negative, antibiotic discontinuation is safe.

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Development and Assessment of Objective Surveillance Definitions for Nonventilator Hospital-Acquired Pneumonia

McKenna

Ochoa

et al. 2019

JAMA Netw Open

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Key PointsQuestionIs it possible to conduct operational surveillance using the clinical data routinely recorded in electronic health records to identify nonventilated adults with hospital-acquired pneumonia?FindingsIn this cohort study of 310 651 patients with 489 519 admissions, an electronic surveillance definition based on worsening oxygenation, at least 3 days of new antibiotics, fever or abnormal white blood cell count, and performance of chest imaging was successfully applied to all patients. This definition identified 0.6 event per 100 admissions and was associated with up to a 6-fold higher risk of hospital death compared with matched control patients.MeaningThis study suggests that electronic surveillance for nonventilator hospital-acquired pneumonia is feasible; this approach could inform the development and evaluation of pneumonia prevention programs in hospitals.

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Diagnostic and therapeutic management of nosocomial pneumonia in surgical patients: Results of the Eole study

Abstract: Nosocomial pneumonias in surgical patients are characterized by high frequency of early onset pneumonia, high proportion of nosocomial organisms even in these early onset pneumonias, and moderate mortality rate.

Cited by 90 publications

References 30 publications

Pneumonia associada à ventilação mecânica em Unidade de Terapia Intensiva cirúrgica

Pneumonia associada à ventilação mecânica em Unidade de Terapia Intensiva cirúrgica

Non-Ventilator ICU-Acquired Pneumonia After Cardiothoracic Surgery: Accuracy of Diagnostic Tools and Outcomes

Development and Assessment of Objective Surveillance Definitions for Nonventilator Hospital-Acquired Pneumonia

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