Reliability of the bronchoscopic protected catheter brush in the diagnosis of pneumonia in mechanically ventilated patients

Castro, Felipe Rodrı́guez de; Violan, J. Sole; Capuz, B.; Luna, J.; Rodriguez, B. Gonzalez; Alonso, José Luis

doi:10.1097/00003246-199102000-00010

Cited by 80 publications

(13 citation statements)

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“…The aetiological spectrum of pneumonia in these patients may differ from other reports which analysed the efficacy of PSB in the aetiological diagnosis of pneumonia [17][18][19][20]. According to the present authors9 experience as well as that of other groups, the timing of the presentation of the pulmonary infection and the absence of previous antibiotics modulate the involvement of different causative micro-organisms in the pneumonia.…”

Section: Discussioncontrasting

confidence: 71%

Effects of antibiotics on protected specimen brush sampling in ventilator-associated pneumonia

Prats¹,

Dorca²,

Pujol³

et al. 2002

Eur Respir J

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The effects of antibiotic treatment on the results of protected specimen brushing (PSB) in ventilator-associated pneumonia were prospectively assessed by performing this procedure before antibiotic treatment, and 12, 24, 48 and 72 h after initiation of antibiotic treatment, in 35 ventilated patients who developed pneumonia during mechanical ventilation.The number of micro-organisms isolated, their concentration (colony-forming units (cfu)?mL -1 ), and the number of cases with a positive PSB (o10 3 cfu?mL -1 ) were evaluated.Within 12 h of the initiation of effective antibiotic treatment a rapid, significant decrease in the numbers of organisms isolated, their individual concentrations and the percentage of positive PSB results were observed. Certain bacterial species (Streptococcus pneumoniae, Haemophilus influenzee) appeared to be more vulnerable to antibiotics than others (Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumanni).This data confirms that prior antibiotic treatment, even after only a few hours of activity, significantly decreases the sensitivity of protected brush specimen; this effect appears to be particularly marked among the species involved in early ventilator associated pneumonia. Eur Respir J 2002; 19: 944-951.

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Section: Discussioncontrasting

confidence: 71%

Effects of antibiotics on protected specimen brush sampling in ventilator-associated pneumonia

Prats¹,

Dorca²,

Pujol³

et al. 2002

Eur Respir J

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“…The specificity obtained in our PSB-BF study was similar to that reported by many authors [10,[28][29][30]35].…”

Section: Discussionsupporting

confidence: 92%

“…The diagnostic yield from the PSB-BF in our study was similar to that obtained by several investigators [10,18,24], but lower than that reported by others [30,33,34], perhaps due to difference in culture methodology. The specificity obtained in our PSB-BF study was similar to that reported by many authors [10,[28][29][30]35].…”

Section: Discussionsupporting

confidence: 85%

“…(lung biopsy and blood culture) have some limitations in their specificity [23]. As it is difficult to establish in practice a diagnosis of true VAP, most of the published studies have been made in patients with suspected VAP based on clinical criteria [9][10][11][12][13][14][24][25][26][27][28][29][30], as we did in our study. Some microorganisms, especially Haemophilus influenzae, Streptococcus pneumoniae, L. pneumophila and anaerobic bacteria, are very sensitive to saline transport media, and their concentrations decrease from 97 to 45% after one hour of exposure [31].…”

Section: Discussionmentioning

confidence: 99%

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"Blind" protected specimen brushing <I>versus</I> bronchoscopic techniques in the aetiolological diagnosis of ventilator-associated pneumonia

Bello

Tajada²,

Chacón³

et al. 1996

European Respiratory Journal

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The aetiological diagnosis of nosocomial pneumonia in intensive care unit (ICU) patients requires a valid, cheap and safe method. This method should be suitable for all mechanically-ventilated patients and all ICUs. The aim of this study was to assess the diagnostic yields of three methods: "blind" bronchial brushing (Accu-Cath)(protective specimen brush-nonbronchofibroscopic (PSB-non BF)); bronchofibroscopic protected specimen brushing (PSB-BF) and bronchoalveolar lavage (BAL).We prospectively studied the diagnostic values of the three methods as well as the agreement between microbiological results in 74 patients with 88 episodes of clinically suspected ventilator-associated pneumonia (VAP) and 22 control subjects. VAP episodes were also divided into those with (n=24) and without antibiotic pretreatment (n=64), and into those with (n=78) and without (n=10) right lower lobe infiltrates on chest radiography.No differences were found as regards the bacteriological yield of the three techniques. Furthermore, the rate of concordant results was high; 92% for PSB-BF and BAL; 84% for PSB-nonBF and BAL; 85% for PSB-nonBF and PSB-BF; and 85% for PSB-nonBF combined with both bronchoscopic techniques. The diagnostic yields in suspected VAP were 66, 59 and 56% for PSB-nonBF, PSB-BF and BAL, respectively.We conclude that "blind" bronchial brushing has similar accuracy to bronchoscopic techniques commonly used in the diagnosis of ventilator-associated pneumonia, constituting an interesting alternative in hospitals where fibreoptic bronchoscopy is not available.

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“…It has been extensively studied [6,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], and shown to have an acceptable diagnostic yield in bacterial pneumonia both in non-intubated and intubated patients. It is now recommended as a reference method in the diagnostic assessment of VAP, provided that the diagnostic threshold of 10 3 colony forming units (cfu·ml -1 ) is used [25][26][27][28].…”

mentioning

confidence: 99%

Diagnostic value of direct examination of the protected specimen brush in ventilator-associated pneumonia

Wallet²,

Nevière³

et al. 1994

Eur Respir J

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Interpretation of the protected specimen brush (PSB) technique is based on quantitative bacterial cultures (QC), which unfortunately requires at least 24 h. We prospectively compared the diagnostic value of direct examination (DE) and QC of PSB specimens in 75 patients with suspected pneumonia. We also determined the optimal technique for DE. QC was performed using the serial dilution technique. From the original suspension, two cytospin slides were obtained and stained by the May-Grunwald Giemsa (MGG) and the Gram method for DE. If the prescreening on the MGG-stained slide was positive, the morphology and the Gram staining of the organisms were assessed on the Gram-stained slide. Using the 10(3) colony forming units (cfu.ml-1) threshold for defining PSB as positive or negative, DE had a sensitivity of 85% and a specificity of 94%. In a parallel in vitro study, 18 pairs of PSB specimens were collected from respiratory secretions inoculated with S. aureus. From each pair, one brush was processed as described above and the other was smeared on a glass slide prior to performance of QC. Using direct smear instead of cytocentrifuged preparation, slightly but significantly affected QC. Direct examination of cytospin slides is highly predictive of quantitative bacterial culture results, and provides rapid information regarding the Gram-stain morphology of the causative organisms. It may therefore guide initial therapy.

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Reliability of the bronchoscopic protected catheter brush in the diagnosis of pneumonia in mechanically ventilated patients

Cited by 80 publications

References 0 publications

Effects of antibiotics on protected specimen brush sampling in ventilator-associated pneumonia

Effects of antibiotics on protected specimen brush sampling in ventilator-associated pneumonia

"Blind" protected specimen brushing <I>versus</I> bronchoscopic techniques in the aetiolological diagnosis of ventilator-associated pneumonia

Diagnostic value of direct examination of the protected specimen brush in ventilator-associated pneumonia

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