Efficacy of Bilateral Bronchoalveolar Lavage for Diagnosis of Ventilator-Associated Pneumonia

Zaccard, Colleen R.; Schell, Ronald F.; Spiegel, Carol A.

doi:10.1128/jcm.00747-09

Cited by 23 publications

(28 citation statements)

References 16 publications

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“…The same phenomenon has been encountered with bacteriological verification, which has varied in different VAP studies from 22 to 71% among clinically diagnosed cases [4]. However, there is still controversy about whether and which quantitative cultures are needed for routine diagnosis of pneumonia in the ICU [5][6][7][8][9][10].…”

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confidence: 78%

The Occurrence of Pneumonia Diagnosis Among Neurosurgical Patients: The Definition Matters

et al. 2011

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There was great variability in the presence of pneumonia among neurosurgical patients, depending on the criteria used. Our results support the idea that a more exact method for pneumonia diagnosis should be implemented to obtain more reliable results in this important infection of hospitalized patients, which is also used for benchmarking purposes. Furthermore, it seems important to treat all clinically suspected pneumonia cases whether or not the surveillance criteria are fulfilled.

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confidence: 78%

The Occurrence of Pneumonia Diagnosis Among Neurosurgical Patients: The Definition Matters

et al. 2011

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“…Aspiration of secretions by the bronchoscope was avoided. This procedure was repeated in the contralateral lung, and samples were preserved at ambient temperatures or 4°C before being transported to the microbiology laboratory within 2 h of collection [12, 13]. …”

Section: Methodsmentioning

confidence: 99%

Integron-Mediated Antibiotic Resistance inAcinetobacter baumanniiIsolated from Intensive Care Unit Patients, Babol, North of Iran

Salehi

Ferdosi-Shahandashti

Yahyapour

et al. 2017

BioMed Research International

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Background We investigated the integron types and their relation with antibiotic resistance among A. baumannii isolates collected from intensive care unit patients, Babol, north of Iran. Methods In this cross-sectional study, a total of 73 bronchoalveolar lavage samples were obtained from patients in ICU. Susceptibility testing was performed by disk diffusion method. Types of integrons were identified by an integrase gene PCR. Results In total, 47.9% A. baumannii isolates were recovered from the BAL samples. All isolates were resistant to ceftazidime. 91.4% and 58.3% of isolates were MDR and XDR, respectively. The rate of colistin resistance with the E-test was 5.7%. Molecular analysis of class I, II, and III integrons showed that 25.7%, 88.6%, and 28.6% of the isolates carried the intI, intII, and intIII genes, respectively. Discussion Our results show that different classes of integrons are commonly spread among A. baumannii strains and these genomic segments can play an important role in the acquisition of MDR and XDR phenotypes. So monitoring drug resistance in A. baumannii isolates with the use of int gene PCR is very important to plan specific infection control measures to prevent the spread of MDR-AB and XDR-AB in Iran's hospitals.

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“…5.5 to 6.0 log 10 CFU/ml. It is clear that many patients' burdens will be greater, and some will be in the range of 8.0 to 9.0 log 10 CFU/ml (11). For this patient group, then, chemotherapy must be considerably better than in patients with lower bacterial burdens in order to obtain a good outcome.…”

Section: Discussionmentioning

confidence: 99%

Saturability of Granulocyte Kill of Pseudomonas aeruginosa in a Murine Model of Pneumonia

Drusano

VanScoy

Liu

et al. 2011

Antimicrob Agents Chemother

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Outcomes for patients with dense bacterial burdens, such as ventilator-associated pneumonia (VAP) patients, are often critically influenced by the adequacy of antimicrobial chemotherapy and by the response of the immune system, particularly the granulocytes. Little information is available about the quantitation of kill of organisms over time by granulocytes. In this investigation, we examined the impact of the baseline bacterial burden on the ability of granulocytes alone (without chemotherapy) to keep the number of organisms in check or to kill them over a 24-h period. Pseudomonas aeruginosa ATCC 27853 was the study organism, and we employed a murine pneumonia model (granulocyte replete) for the study. We found that the ability of the immune system to kill P. aeruginosa was saturable. The burden at which the system was half saturated was 2.15 ؋ 10 6 ؎ 2.66 ؋ 10 6 CFU/g. Burdens greater than 10 7 CFU/g demonstrated net growth over 24 h. These findings suggest the need for aggressive chemotherapy early in the treatment of VAP to keep the burden from saturating the granulocytes. This should optimize the outcome for these seriously infected patients.We have recently demonstrated that the kill of both Pseudomonas aeruginosa and Staphylococcus aureus by granulocytes is saturable in a mouse thigh infection model in which the animals are granulocyte replete (1). As part of that evaluation, we speculated that the same would be true in the setting of pneumonia and that this phenomenon may explain why some antimicrobial agents that are predicted to be suboptimal based on the exposure achieved at the primary infection site still appear to work, particularly in trials where patients are drawn from the community and where the bacterial burden at the initiation of chemotherapy is modest.While we believed it was likely that the same finding would be demonstrable in the setting of pneumonia, the considerable pathological differences between a murine model reflecting mostly a skin or skin structure type of infection and a murine pneumonia model might be large enough that the findings in the pneumonia model might be substantially different.In this evaluation, we examined the impact of the initial bacterial burden on the ability of granulocytes to limit the expansion of the bacterial population over 24 h in a murine model of Pseudomonas pneumonia. MATERIALS AND METHODSMicroorganisms. Pseudomonas aeruginosa ATCC 27853 was employed. Stocks of the organism were stored in 10% glycerol at Ϫ80°C. The isolate was subcultured on blood agar plates twice before each experiment.Animals. Female 24-to 25-g outbred Swiss Webster mice (Taconic Farms, NY) were used in all in vivo studies. They received food and water ad libitum. All animal experimentation procedures were approved by our Institutional Animal Care and Use Committee (IACUC) and were conducted in accordance with its guidelines.Animal model. Animals were anesthetized with ketamine-xylazine (100 mg/kg ketamine and 6 mg/kg xylazine) via intraperitoneal (i.p.) injection. Pseudomonas aer...

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Efficacy of Bilateral Bronchoalveolar Lavage for Diagnosis of Ventilator-Associated Pneumonia

Abstract: Ventilator-associated pneumonia (VAP) is a common nosocomial infection

Cited by 23 publications

References 16 publications

The Occurrence of Pneumonia Diagnosis Among Neurosurgical Patients: The Definition Matters

The Occurrence of Pneumonia Diagnosis Among Neurosurgical Patients: The Definition Matters

Integron-Mediated Antibiotic Resistance inAcinetobacter baumanniiIsolated from Intensive Care Unit Patients, Babol, North of Iran

Saturability of Granulocyte Kill of Pseudomonas aeruginosa in a Murine Model of Pneumonia

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