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Table 3 Studies comparing quantitative cultures with pathology

From: Diagnosis of ventilator-associated pneumonia: a systematic review of the literature

First author Sample Dx Tests Gold standard Results
Balthazar, 2001, ** [13] Mixed ICU, 37 pts BAL (104) & Gram & cells from BAL Pathology + Culture • BAL: sens = 19%, spec = 94%; fever: sens = 50%, spec = 76%; leucocytosis (>10000): sens = 60%, spec = 76%; Gram stain: sens = 85%, spec = 94%; total cell (>400000): sens = 90%, spec = 94%.
Torres, 2000, ** [26] Medical ICU, 25 pts TBA (105) & PSB (103) & BAL (104) & pBAL (104) Pathology + Culture • TBA: sens = 50%, spec = 67%.
• PSB: sens = 67%, spec = 75%.
• pBAL: sens = 63%, spec = 83%.
• BAL: sens = 83%, spec = 68%.
Fabregas, 1999, ** [11] MIxed ICU, 25 pts Johanson & CPIS & TBA (105), PSB (103), pBAL (104) and BAL (104) Pathology + Culture • Johanson criteria (2): sens = 69%, spec = 75%.
• Any Johanson criteria: Chest Rx: sens = 92%, spec = 33%; leukocytosis: sens = 77%, spec = 58%; fever: sens = 46%, spec = 42%; purulent secretions: sens = 69%, spec = 42%.
• CPIS: sens = 77%, spec = 42%.
• TBA: sens = 69%, spec = 92%.
• pBAL: sens = 39%, spec = 100%.
• BAL: sens = 77%, spec = 58%.
• PSB: sens = 62%, spec = 75%.
• QtC increased little to clinical diagnosis accuracy.
Papazian, 1997, # [29] Mixed ICU, 28 pts Gram & ICO Pathology + Culture • BBS Gram stain: sens = 56%, spec = 73%.
• mini-BAL Gram Stain: sens = 44%, spec = 87%.
• BAL Gram stain: sens = 56%, spec = 100%.
• BBS ICO (>10%): sens = 56%, spec = 40%.
• Mini-BAL ICO (>5%): sens = 67%, spec = 53%.
• BAL ICO (>4%): sens = 56%, spec = 40%.
Kirtland, 1997, ** [27] Mixed ICU, 39 pts TA &PSB & pPSB & BAL & BAL cells Pathology + Culture • TA: sens = 87%, spec = 31%.
• pPSB: sens = 30%, spec = 81%.
• PSB: sens = 44%, spec = 81%.
• BAL: sens = 65%, spec = 63%.
• >50% neutrophils in BAL: sens = 100%.
Marquette, 1995, ** [28] Mixed ICU, 28 pts TA (105 & 106) & PSB (103) & BAL (104) Pathology • TA (105): sens = 63%, spec = 75%.
• TA (106): sens = 50%, spec = 85%.
• PSB (103): sens = 57%, spec = 88%.
• BAL (104): sens = 47%, spec = 100%.
• ICO (any%): sens = 36%, spec = 100%.
Torres, 1996 *, ** [25] Mixed ICU, 25 pts ICO (≥ 5%), mini-BAL (104) & BAL (104) Pathology • ICO (≥ 5%) compared to mini-BAL: PPV = 75%, NPV = 83%.
• ICO (≥ 5%) compared to BAL: PPV = 57%, NPV = 8 3%.
• Mini-BAL: sens = 22%, spec = 100%.
• BAL: sens = 45%, spec = 55%.
Papazian, 1995, ** [17] MIxed ICU, 38 pts BBS (104) & mini-BAL (103) & PSB (103) & BAL (104) & CPIS Pathology + Culture • CPIS: sens = 72%, spec = 85%.
• BBS (104): sens = 83%, spec = 80%.
• mini-BAL (103): sens = 67%, spec = 80%.
• BAL (104): sens = 58%, spec = 95%.
• PSB (103): sens = 42%, spec = 95%.
Torres, 1994, ** [24] Mixed ICU, 30 pts TBA (105) & PSB (103) & BAL (104) & Clinical data Pathology • Clinical data: fever: sens = 55%, spec = 58%; purulent secretions: sens = 83%, spec = 33%; Rx infiltrate: sens = 78%, spec = 42%.
• Pulmonary biopsy culture (≥103): sens = 40%, spec = 45%.
• Quantitative cultures: TBA: sens = 44%, spec = 48%; PSB: sens = 36%, spec = 50%; BAL: sens = 50%, spec = 45%.
Rouby, 1989, ** [30] Surgical ICU, 59 pts pBAL Pathology + culture • pBAL: sens = 80%, spec = 66% to identify VAP; sens = 73% to identify the microorganism.
Chastre, 1984, ** [10] Mixed ICU, 26 pts PSB (103) Lung culture • PSB correlated well to lung cultures, especially in the subgroup of patients who received no antibiotics during the week preceding their death.
  1. ICU = intensive care unit; BAL = bronchoalveolar lavage; sens = sensitivity; spec = specificity; TBA = tracheobronchial aspirate; PSB = protected specimen brush; pBAL = protected BAL or 'mini-BAL'; CPIS = clinical pulmonary infection score; QtC = quantitative culture; ICO = intracellular organism; BBS = blind bronchial sampling; TA = tracheal aspiration; PPV = positive predictive value; NPV = negative predictive value; * = retrospective; ** = consecutive; # convenient