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Ventilator associated pneumonia: comparison between quantitative and qualitative cultures of tracheal aspirates

INTRODUCTION: Deferred or inappropriate antibiotic treatment in ventilator-associated pneumonia (VAP) is associated with increased mortality, and clinical and radiological criteria are frequently employed to establish an early diagnosis. Culture results are used to confirm the clinical diagnosis and...

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Autores principales: Camargo, Luis Fernando Aranha, De Marco, Fernando Vinícius, Barbas, Carmen Sílvia Valente, Hoelz, Cristiane, Bueno, Marco Aurélio Scarpinella, Rodrigues Jr, Milton, Amado, Verônica Moreira, Caserta, Raquel, Martino, Marinês Dalla Valle, Pasternak, Jacyr, Knobel, Elias
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2004
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1065063/
https://www.ncbi.nlm.nih.gov/pubmed/15566587
http://dx.doi.org/10.1186/cc2965
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author Camargo, Luis Fernando Aranha
De Marco, Fernando Vinícius
Barbas, Carmen Sílvia Valente
Hoelz, Cristiane
Bueno, Marco Aurélio Scarpinella
Rodrigues Jr, Milton
Amado, Verônica Moreira
Caserta, Raquel
Martino, Marinês Dalla Valle
Pasternak, Jacyr
Knobel, Elias
author_facet Camargo, Luis Fernando Aranha
De Marco, Fernando Vinícius
Barbas, Carmen Sílvia Valente
Hoelz, Cristiane
Bueno, Marco Aurélio Scarpinella
Rodrigues Jr, Milton
Amado, Verônica Moreira
Caserta, Raquel
Martino, Marinês Dalla Valle
Pasternak, Jacyr
Knobel, Elias
author_sort Camargo, Luis Fernando Aranha
collection PubMed
description INTRODUCTION: Deferred or inappropriate antibiotic treatment in ventilator-associated pneumonia (VAP) is associated with increased mortality, and clinical and radiological criteria are frequently employed to establish an early diagnosis. Culture results are used to confirm the clinical diagnosis and to adjust or sometimes withdraw antibiotic treatment. Tracheal aspirates have been shown to be useful for these purposes. Nonetheless, little is known about the usefulness of quantitative findings in tracheal secretions for diagnosing VAP. METHODS: To determine the value of quantification of bacterial colonies in tracheal aspirates for diagnosing VAP, we conducted a prospective follow-up study of 106 intensive care unit patients who were under ventilatory support. In total, the findings from 219 sequential weekly evaluations for VAP were examined. Clinical and radiological parameters were recorded and evaluated by three independent experts; a diagnosis of VAP required the agreement of at least two of the three experts. At the same time, cultures of tracheal aspirates were analyzed qualitatively and quantitatively (10(5 )colony-forming units [cfu]/ml and 10(6 )cfu/ml) RESULTS: Quantitative cultures of tracheal aspirates (10(5 )cfu/ml and 10(6 )cfu/ml) exhibited increased specificity (48% and 78%, respectively) over qualitative cultures (23%), but decreased sensitivity (26% and 65%, respectively) as compared with the qualitative findings (81%). Quantification did not improve the ability to predict a diagnosis of VAP. CONCLUSION: Quantitative cultures of tracheal aspirates in selected critically ill patients have decreased sensitivity when compared with qualitative results, and they should not replace the latter to confirm a clinical diagnosis of VAP or to adjust antimicrobial therapy.
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spelling pubmed-10650632005-03-16 Ventilator associated pneumonia: comparison between quantitative and qualitative cultures of tracheal aspirates Camargo, Luis Fernando Aranha De Marco, Fernando Vinícius Barbas, Carmen Sílvia Valente Hoelz, Cristiane Bueno, Marco Aurélio Scarpinella Rodrigues Jr, Milton Amado, Verônica Moreira Caserta, Raquel Martino, Marinês Dalla Valle Pasternak, Jacyr Knobel, Elias Crit Care Research INTRODUCTION: Deferred or inappropriate antibiotic treatment in ventilator-associated pneumonia (VAP) is associated with increased mortality, and clinical and radiological criteria are frequently employed to establish an early diagnosis. Culture results are used to confirm the clinical diagnosis and to adjust or sometimes withdraw antibiotic treatment. Tracheal aspirates have been shown to be useful for these purposes. Nonetheless, little is known about the usefulness of quantitative findings in tracheal secretions for diagnosing VAP. METHODS: To determine the value of quantification of bacterial colonies in tracheal aspirates for diagnosing VAP, we conducted a prospective follow-up study of 106 intensive care unit patients who were under ventilatory support. In total, the findings from 219 sequential weekly evaluations for VAP were examined. Clinical and radiological parameters were recorded and evaluated by three independent experts; a diagnosis of VAP required the agreement of at least two of the three experts. At the same time, cultures of tracheal aspirates were analyzed qualitatively and quantitatively (10(5 )colony-forming units [cfu]/ml and 10(6 )cfu/ml) RESULTS: Quantitative cultures of tracheal aspirates (10(5 )cfu/ml and 10(6 )cfu/ml) exhibited increased specificity (48% and 78%, respectively) over qualitative cultures (23%), but decreased sensitivity (26% and 65%, respectively) as compared with the qualitative findings (81%). Quantification did not improve the ability to predict a diagnosis of VAP. CONCLUSION: Quantitative cultures of tracheal aspirates in selected critically ill patients have decreased sensitivity when compared with qualitative results, and they should not replace the latter to confirm a clinical diagnosis of VAP or to adjust antimicrobial therapy. BioMed Central 2004 2004-10-14 /pmc/articles/PMC1065063/ /pubmed/15566587 http://dx.doi.org/10.1186/cc2965 Text en Copyright © 2004 Camargo et al., licensee BioMed Central Ltd.
spellingShingle Research
Camargo, Luis Fernando Aranha
De Marco, Fernando Vinícius
Barbas, Carmen Sílvia Valente
Hoelz, Cristiane
Bueno, Marco Aurélio Scarpinella
Rodrigues Jr, Milton
Amado, Verônica Moreira
Caserta, Raquel
Martino, Marinês Dalla Valle
Pasternak, Jacyr
Knobel, Elias
Ventilator associated pneumonia: comparison between quantitative and qualitative cultures of tracheal aspirates
title Ventilator associated pneumonia: comparison between quantitative and qualitative cultures of tracheal aspirates
title_full Ventilator associated pneumonia: comparison between quantitative and qualitative cultures of tracheal aspirates
title_fullStr Ventilator associated pneumonia: comparison between quantitative and qualitative cultures of tracheal aspirates
title_full_unstemmed Ventilator associated pneumonia: comparison between quantitative and qualitative cultures of tracheal aspirates
title_short Ventilator associated pneumonia: comparison between quantitative and qualitative cultures of tracheal aspirates
title_sort ventilator associated pneumonia: comparison between quantitative and qualitative cultures of tracheal aspirates
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1065063/
https://www.ncbi.nlm.nih.gov/pubmed/15566587
http://dx.doi.org/10.1186/cc2965
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