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

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

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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, P056 (2000). https://doi.org/10.1186/cc431

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Keywords

  • Pneumonia
  • Staphylococcus Aureus
  • Pseudomonas Aeruginosas
  • Antimicrobial Therapy
  • Pulmonary Infection