Is a Strategy Based on Routine Endotracheal Cultures the Best Way to Prescribe Antibiotics in Ventilator-Associated Pneumonia?

Luna, Carlos M.; Sarquís, Sergio; Niederman, Michael S.; Sosa, Fernando; Otaola, María; Bailleau, Nicolas; Vay, Carlos; Famiglietti, Ángela; Irrazabal, Célica; Capdevila, Abelardo

doi:10.1378/chest.12-1477

Cited by 46 publications

(32 citation statements)

References 21 publications

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“…The trachea may not be the ideal location to study pneumonia, as this disease is defined by the infection of the bronchia and alveoli. Indeed, ETA cultures have a limited predictive value for VAP compared with BAL 35. This might also explain that the sequencing results did not correspond to the culture results, although this was observed previously in other studies that used BAL fluid as well 25 36.…”

Section: Discussionmentioning

confidence: 73%

The dynamics of the pulmonary microbiome during mechanical ventilation in the intensive care unit and the association with occurrence of pneumonia

Zakharkina

Martín‐Loeches

Matamoros

et al. 2017

Thorax

145

125

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Section: Discussionmentioning

confidence: 73%

The dynamics of the pulmonary microbiome during mechanical ventilation in the intensive care unit and the association with occurrence of pneumonia

Zakharkina

Martín‐Loeches

Matamoros

et al. 2017

Thorax

145

125

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“…Luna and associates prospectively studied an antibiotic strategy based on routine endotracheal aspirate (ETA) culture in 283 ventilated patients, compared to empiric therapy based on the 2005 ATS/IDSA guidelines [54]. Sensitivity for ETA to predict a BAL-obtained pathogen was 62.4 % and was better if done within 3 days of VAP onset.…”

Section: Role Of Surveillance Culture For De-escalationmentioning

confidence: 99%

Ventilator-associated pneumonia: present understanding and ongoing debates

2014

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The morbidity and mortality related to VAP remain high and, in the absence of a gold standard test for diagnosis, suspected VAP patients should be started on antibiotics based on recommendations per the 2005 ATS guidelines and knowledge of local antibiotic susceptibility patterns. Using a combination of clinical severity scores, biomarkers, and cultures might help with reducing the duration of therapy and achieving antibiotic de-escalation.

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“…Otherwise, an ETA was considered to be unavailable. The 3-day interval was chosen because significant changes in ETA results are unlikely to occur within this time frame, and this interval proved to be superior for antibiotic guidance than was a 7-day interval (20,21). Paired ETA-BALF samples were subsequently compared.…”

Section: Settingmentioning

confidence: 99%

“…7 CFU/ml are used (17,21,31,32). Using various thresholds for positivity in the studied population contributes to heterogeneity and thereby makes study results difficult to compare.…”

Section: Culturesmentioning

confidence: 99%

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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Is a Strategy Based on Routine Endotracheal Cultures the Best Way to Prescribe Antibiotics in Ventilator-Associated Pneumonia?

Cited by 46 publications

References 21 publications

The dynamics of the pulmonary microbiome during mechanical ventilation in the intensive care unit and the association with occurrence of pneumonia

The dynamics of the pulmonary microbiome during mechanical ventilation in the intensive care unit and the association with occurrence of pneumonia

Ventilator-associated pneumonia: present understanding and ongoing debates

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

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