Cargando…
Quantitative culture of endotracheal aspirate and BAL fluid samples in the management of patients with ventilator-associated pneumonia: a randomized clinical trial
OBJECTIVE: To compare 28-day mortality rates and clinical outcomes in ICU patients with ventilator-associated pneumonia according to the diagnostic strategy used. METHODS: This was a prospective randomized clinical trial. Of the 73 patients included in the study, 36 and 37 were randomized to undergo...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Sociedade Brasileira de Pneumologia e Tisiologia
2014
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301249/ https://www.ncbi.nlm.nih.gov/pubmed/25610505 http://dx.doi.org/10.1590/S1806-37132014000600008 |
_version_ | 1782353634106802176 |
---|---|
author | Corrêa, Ricardo de Amorim Luna, Carlos Michel dos Anjos, José Carlos Fernandez Versiani Barbosa, Eurípedes Alvarenga de Rezende, Cláudia Juliana Rezende, Adriano Pereira Pereira, Fernando Henrique Rocha, Manoel Otávio da Costa |
author_facet | Corrêa, Ricardo de Amorim Luna, Carlos Michel dos Anjos, José Carlos Fernandez Versiani Barbosa, Eurípedes Alvarenga de Rezende, Cláudia Juliana Rezende, Adriano Pereira Pereira, Fernando Henrique Rocha, Manoel Otávio da Costa |
author_sort | Corrêa, Ricardo de Amorim |
collection | PubMed |
description | OBJECTIVE: To compare 28-day mortality rates and clinical outcomes in ICU patients with ventilator-associated pneumonia according to the diagnostic strategy used. METHODS: This was a prospective randomized clinical trial. Of the 73 patients included in the study, 36 and 37 were randomized to undergo BAL or endotracheal aspiration (EA), respectively. Antibiotic therapy was based on guidelines and was adjusted according to the results of quantitative cultures. RESULTS: The 28-day mortality rate was similar in the BAL and EA groups (25.0% and 37.8%, respectively; p = 0.353). There were no differences between the groups regarding the duration of mechanical ventilation, antibiotic therapy, secondary complications, VAP recurrence, or length of ICU and hospital stay. Initial antibiotic therapy was deemed appropriate in 28 (77.8%) and 30 (83.3%) of the patients in the BAL and EA groups, respectively (p = 0.551). The 28-day mortality rate was not associated with the appropriateness of initial therapy in the BAL and EA groups (appropriate therapy: 35.7% vs. 43.3%; p = 0.553; and inappropriate therapy: 62.5% vs. 50.0%; p = 1.000). Previous use of antibiotics did not affect the culture yield in the EA or BAL group (p = 0.130 and p = 0.484, respectively). CONCLUSIONS: In the context of this study, the management of VAP patients, based on the results of quantitative endotracheal aspirate cultures, led to similar clinical outcomes to those obtained with the results of quantitative BAL fluid cultures. |
format | Online Article Text |
id | pubmed-4301249 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Sociedade Brasileira de Pneumologia e Tisiologia |
record_format | MEDLINE/PubMed |
spelling | pubmed-43012492015-01-21 Quantitative culture of endotracheal aspirate and BAL fluid samples in the management of patients with ventilator-associated pneumonia: a randomized clinical trial Corrêa, Ricardo de Amorim Luna, Carlos Michel dos Anjos, José Carlos Fernandez Versiani Barbosa, Eurípedes Alvarenga de Rezende, Cláudia Juliana Rezende, Adriano Pereira Pereira, Fernando Henrique Rocha, Manoel Otávio da Costa J Bras Pneumol Original Articles OBJECTIVE: To compare 28-day mortality rates and clinical outcomes in ICU patients with ventilator-associated pneumonia according to the diagnostic strategy used. METHODS: This was a prospective randomized clinical trial. Of the 73 patients included in the study, 36 and 37 were randomized to undergo BAL or endotracheal aspiration (EA), respectively. Antibiotic therapy was based on guidelines and was adjusted according to the results of quantitative cultures. RESULTS: The 28-day mortality rate was similar in the BAL and EA groups (25.0% and 37.8%, respectively; p = 0.353). There were no differences between the groups regarding the duration of mechanical ventilation, antibiotic therapy, secondary complications, VAP recurrence, or length of ICU and hospital stay. Initial antibiotic therapy was deemed appropriate in 28 (77.8%) and 30 (83.3%) of the patients in the BAL and EA groups, respectively (p = 0.551). The 28-day mortality rate was not associated with the appropriateness of initial therapy in the BAL and EA groups (appropriate therapy: 35.7% vs. 43.3%; p = 0.553; and inappropriate therapy: 62.5% vs. 50.0%; p = 1.000). Previous use of antibiotics did not affect the culture yield in the EA or BAL group (p = 0.130 and p = 0.484, respectively). CONCLUSIONS: In the context of this study, the management of VAP patients, based on the results of quantitative endotracheal aspirate cultures, led to similar clinical outcomes to those obtained with the results of quantitative BAL fluid cultures. Sociedade Brasileira de Pneumologia e Tisiologia 2014 /pmc/articles/PMC4301249/ /pubmed/25610505 http://dx.doi.org/10.1590/S1806-37132014000600008 Text en http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Corrêa, Ricardo de Amorim Luna, Carlos Michel dos Anjos, José Carlos Fernandez Versiani Barbosa, Eurípedes Alvarenga de Rezende, Cláudia Juliana Rezende, Adriano Pereira Pereira, Fernando Henrique Rocha, Manoel Otávio da Costa Quantitative culture of endotracheal aspirate and BAL fluid samples in the management of patients with ventilator-associated pneumonia: a randomized clinical trial |
title | Quantitative culture of endotracheal aspirate and BAL fluid samples in the management of patients with ventilator-associated pneumonia: a randomized clinical trial
|
title_full | Quantitative culture of endotracheal aspirate and BAL fluid samples in the management of patients with ventilator-associated pneumonia: a randomized clinical trial
|
title_fullStr | Quantitative culture of endotracheal aspirate and BAL fluid samples in the management of patients with ventilator-associated pneumonia: a randomized clinical trial
|
title_full_unstemmed | Quantitative culture of endotracheal aspirate and BAL fluid samples in the management of patients with ventilator-associated pneumonia: a randomized clinical trial
|
title_short | Quantitative culture of endotracheal aspirate and BAL fluid samples in the management of patients with ventilator-associated pneumonia: a randomized clinical trial
|
title_sort | quantitative culture of endotracheal aspirate and bal fluid samples in the management of patients with ventilator-associated pneumonia: a randomized clinical trial |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301249/ https://www.ncbi.nlm.nih.gov/pubmed/25610505 http://dx.doi.org/10.1590/S1806-37132014000600008 |
work_keys_str_mv | AT correaricardodeamorim quantitativecultureofendotrachealaspirateandbalfluidsamplesinthemanagementofpatientswithventilatorassociatedpneumoniaarandomizedclinicaltrial AT lunacarlosmichel quantitativecultureofendotrachealaspirateandbalfluidsamplesinthemanagementofpatientswithventilatorassociatedpneumoniaarandomizedclinicaltrial AT dosanjosjosecarlosfernandezversiani quantitativecultureofendotrachealaspirateandbalfluidsamplesinthemanagementofpatientswithventilatorassociatedpneumoniaarandomizedclinicaltrial AT barbosaeuripedesalvarenga quantitativecultureofendotrachealaspirateandbalfluidsamplesinthemanagementofpatientswithventilatorassociatedpneumoniaarandomizedclinicaltrial AT derezendeclaudiajuliana quantitativecultureofendotrachealaspirateandbalfluidsamplesinthemanagementofpatientswithventilatorassociatedpneumoniaarandomizedclinicaltrial AT rezendeadrianopereira quantitativecultureofendotrachealaspirateandbalfluidsamplesinthemanagementofpatientswithventilatorassociatedpneumoniaarandomizedclinicaltrial AT pereirafernandohenrique quantitativecultureofendotrachealaspirateandbalfluidsamplesinthemanagementofpatientswithventilatorassociatedpneumoniaarandomizedclinicaltrial AT rochamanoelotaviodacosta quantitativecultureofendotrachealaspirateandbalfluidsamplesinthemanagementofpatientswithventilatorassociatedpneumoniaarandomizedclinicaltrial |