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Are routine endotracheal aspirates predictive of the etiology of ventilator-associated pneumonia?

Introduction

Most investigators discuss the predictive value of respiratory surveillance cultures in mechanically ventilated patients and doubt on the appropriate selection of the antibiotic therapy based on these findings, when pneumonia develops. The aim of our study was to evaluate whether microorganisms cultured from semiquantitative tracheal aspirates (SQTA) in the 48 hours prior to the clinical suspicion of ventilator-associated pneumonia (VAP) were predictive of the etiology, compared with the bronchoalveolar lavage (BAL) results performed on the same day that the clinical diagnosis was considered

Methods

Routine SQTA were performed twice weekly in all intubated patients for over 72 hours according to the methodology described elsewhere [1]. Fiberoptic bronchoscopy with BAL was preformed the same day that VAP was suspected according to Johanson criteria (fever, leucocytosis, purulent secretions and infiltrate on radiograph) plus gas-exchange deterioration.

Results

In our 22-bed ICU, during a 27-month period, 156 patients underwent BAL procedures due to clinical suspicion of VAP. Out of these, 118 patients (120 BAL) had semiquantitative tracheal aspirate (SQTA) performed 48 hours prior to the clinical diagnosis of VAP (males 71/118; mean age 47 ± 16 years; SAPS II 35 ± 10). See Table 1 for pathogen prediction by SQTA surveillance cultures. See Table 2 for concordance of SQTA–BAL when only multiresistant microorganisms are considered. Negative BAL cultures with SQTA growth were never found. Polymicrobial SQTA cultures: 13 concordant, seven only partial concordant, four not concordant. There was no incidence in our results related to previous antibiotic therapy: 33% of the concordant, 24% of the partial concordant and 29% of the no concordant were on antibiotics when SQTA was obtained.

Table 1
Table 2

Conclusion

In our patient population, routine surveillance SQTA cultures accurately predict more than 60% of the etiologic agents of VAP. This prediction increases to 80% when multiresistant microorganisms are considered. Due to routine surveillance cultures, our antibiotic prescriptions can become more adequate.

References

  1. 1.

    James L, Hoppe-Bauer JE: Processing and interpretation of lower resp tract in specimens. In Clinical Microbiology Procedures Handbook. Edited by: Isenberg HD. Washington, DC: ASM Press; 1992:1.15.1-1.15.8.

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Bagnulo, H., Godino, M., Galiana, A. et al. Are routine endotracheal aspirates predictive of the etiology of ventilator-associated pneumonia?. Crit Care 11, P87 (2007). https://doi.org/10.1186/cc5247

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Keywords

  • Antibiotic Therapy
  • Clinical Suspicion
  • Antibiotic Prescription
  • Routine Surveillance
  • Fiberoptic Bronchoscopy