B. Jourdain et al., ROLE OF QUANTITATIVE CULTURES OF ENDOTRACHEAL ASPIRATES IN THE DIAGNOSIS OF NOSOCOMIAL PNEUMONIA, American journal of respiratory and critical care medicine, 152(1), 1995, pp. 241-246
Citations number
22
Categorie Soggetti
Emergency Medicine & Critical Care","Respiratory System
To assess the reliability of quantitative cultures of endotracheal asp
irates (EA) to diagnose,ventilator-associated pneumonia, fiberoptic br
onchoscopy was used to study 57 episodes of suspected lung infection i
n 39 patients with no recent changes in antimicrobial chemotherapy. A
total of 19 cases (33%) of pneumonia were diagnosed based on the follo
wing criteria: protected specimen brush (PBS) sampling yielding greate
r than or equal to 10(3) cfu/ml of at least one microorganism and/or g
reater than or equal to 5% of cells containing intracellular bacteria
on direct examination of bronchoalveolar lavage (BAL). The operating c
haracteristics of EA cultures were calculated over a range of cutoff v
alues (from 10(3) to 10(7) cfu/ml), and the threshold of 10(6) cfu/ml
appeared to be the most accurate, with a sensitivity of 68% and a spec
ificity of 84%. Microorganisms cultured from EA samples correlated wea
kly with those obtained using PSB specimens (rho = 0.32), with only 49
microorganisms among 123 (40%) found in both samples. These latter re
sults and the relatively low sensitivity of the technique indicate tha
t EA quantitative cultures are of limited value for the diagnosis of p
neumonia in ventilated patients when fiberoptic techniques are availab
le.