EFFICACY, SAFETY, AND THERAPEUTIC RELEVANCE OF TRANSTHORACIC ASPIRATION WITH ULTRATHIN NEEDLE IN NONVENTILATED NOSOCOMIAL PNEUMONIA

In order to determine the potential indications of transthoracic needl e aspiration (TNA) using the ultrathin 25G needle for the diagnosis of nonopportunistic lung infections, we prospectively analyzed the diagn ostic efficacy, safety, and therapeutic implications of its results in 97 patients with nonventilated nosocomial pneumonias (NVNP). The sens itivity of TNA was 60.9%. Specificity and positive predictive value (P PV) were 100%. Negative predictive value (NPV) was 34.1%. The complica tions in the studied cases were nil in 89 cases (91.8%), transient hem optoic expectoration (< 10 ml) in five (5.2%), and self-limited partia l pneumothorax in three (3.1%). No complications needing treatment wer e observed. On the basis of a positive TNA result, the initial antibio tic treatment was modified in 29 of 97 (29.9%) cases. In twelve of the se, the empirical antibiotic regimen was demonstrated to be ineffectiv e. We conclude that, using the 25G needle, TNA has a good diagnostic e fficacy and is a safe procedure for the etiologic investigation of NVN P. A positive TNA result has significant therapeutic relevance, even i n cases where broad-spectrum antibiotics are empirically prescribed.