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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...

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Autores principales: 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
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
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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.
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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
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