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Protected specimen brush bronchoscopically directed versus unprotected tracheal aspirate in patients with ventilator associated pneumonia
Critical Care volume 3, Article number: P056 (2000)
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
References
Baselski VS, EI-Torky M, Coalson JJ, Griffin JP: The standardization of criteria for processing and interpreting laboratory specimens in patients with suspected ventilator-associated pneumonia. Chest 1992, 102: 571S-579S. 10.1378/chest.102.5_Supplement_1.571S
Jourdain B, Novara A, Joly-Guillou , et al.: Role of quantitative cultures of endotracheal aspirates in the diagnosis of nosocomial pneumonia. Am J Respir Crit Care Med 1995, 152: 241-246.
Pingleton SK, Fagon JY, Leeper KV: Patient selection for clinical investigation of ventilator-associated pneumonia. Critera for evaluating diagnostic techniques. Chest 1992, 102 (Suppl 1): 553S-556S. 10.1378/chest.102.5_Supplement_1.553S
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Morra, S., Laudi, C., Nespoli, F. et al. Protected specimen brush bronchoscopically directed versus unprotected tracheal aspirate in patients with ventilator associated pneumonia. Crit Care 3 (Suppl 1), P056 (2000). https://doi.org/10.1186/cc431
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DOI: https://doi.org/10.1186/cc431