Am. Baker et al., DECISION-MAKING IN NOSOCOMIAL PNEUMONIA - AN ANALYTIC APPROACH TO THEINTERPRETATION OF QUANTITATIVE BRONCHOSCOPIC CULTURES, Chest, 107(1), 1995, pp. 85-95
Quantitative cultures of specimens obtained at fiberoptic bronchoscopy
have been used to diagnose nosocomial pneumonia in research settings,
but their clinical role remains controversial. We reviewed the litera
ture comparing these culture techniques with other accepted methods to
diagnose pneumonia in mechanically ventilated patients and extracted
data to describe the receiver operator characteristics (ROC) of quanti
tative cultures of protected specimen brush (PSB) and bronchoalveolar
lavage (BAL) samples. Analysis of ROCs reveals that these tests have a
discriminating power comparable or superior to that of many widely ac
cepted routinely used tests. Current data do not suggest that either c
ulture technique offers an advantage over the other. Since benefits of
antibiotic therapy of pneumonia and risks of treatment of noninfected
critically ill patients are not well quantified, universally applicab
le recommendations for appropriate values to define an abnormal test r
esult cannot logically be made. Multiple decision analytic tools show
that values lower than those previously recommended are more appropria
te in patients suspected of having pneumonia unless the risk of antibi
otic therapy is judged to be extreme. On the basis of these findings,
we suggest guidelines for clinicians' interpretation of PSB and BAL qu
antitative culture results.