Protected specimen brush bronchoscopically directed versus unprotected tracheal aspirate in patients with ventilator associated pneumonia

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Abstract

Objectives Bacterial resistance to antimicrobial treatment is actually one of the most debated issue in medical field. Therefore, it is importent to dispose a diagnostic procedure to allow an aimed antimicrobial treatment. Unprotected tracheal aspirate (UTA) is the most widely used sampling technique to assess pulmonary infection even though known to have a high sensivity and a low specificity [1]. Protected specimen brush bronchoscopically directed (PSB) is a procedure that purpose a higher specificity [2]. The aim of the study is to compare both methods for the diagnosis of pneumonia in ICU. Materials and methods 70 consecutive patients admitted to an 8-bed general ICU over a period of 18 months, intubated and mechanically ventilated [3]. When patients met clinical and radiological criteria for suspicion of pneumonia both UTA and PSB were performed. Results Data collected from the two methods pointed out significative differences. PSB vs UTA revealed complete negativeness or growth of different microorganisms in 29 patients (41.5%); this result had statistically significance (P < 0.01). Above all it is to underline that microorganism most frequently represented in UTA and not detected by PSB were in sequence: Candida spp, Pseudomonas aeruginosas, Staphylococcus aureus. No complications were reported during the procedures. Antimicrobial therapy based on PSB data was started, leading to a good clinical response and favourable outcome. Conclusion PSB is a reliable and safe method useful to investigate pulmonary infections. High specificity of the technique allows to aim antibiotic therapy, so reducing the risk of inducing resistance to molecule still effective with a consequent optimization of expenses. UTA and corrispective PSB were both negative in X case (y%) VPN = 1. In consideration of UTA elevated vpn, this method could represent a first diagnostic step followed in case of positiveness by PSB

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Role of quantitative cultures of endotracheal aspirates in the diagnosis of nosocomial pneumonia.

S Calvat, M C Dombret, J Trouillet … (1995)

To assess the reliability of quantitative cultures of endotracheal aspirates (EA) to diagnose ventilator-associated pneumonia, fiberoptic bronchoscopy was used to study 57 episodes of suspected lung infection in 39 patients with no recent changes in antimicrobial chemotherapy. A total of 19 cases (33%) of pneumonia were diagnosed based on the following criteria: protected specimen brush (PBS) sampling yielding > or = 10(3) cfu/ml of at least one microorganism and/or > or = 5% of cells containing intracellular bacteria on direct examination of bronchoalveolar lavage (BAL). The operating characteristics of EA cultures were calculated over a range of cutoff values (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 specificity of 84%. Microorganisms cultured from EA samples correlated weakly with those obtained using PSB specimens (rho = 0.32), with only 49 microorganisms among 123 (40%) found in both samples. These latter results and the relatively low sensitivity of the technique indicate that EA quantitative cultures are of limited value for the diagnosis of pneumonia in ventilated patients when fiberoptic techniques are available.