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Table 4 Studies comparing quantitative cultures using various techniques or cutoff points

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

First author Sample Dx tests Gold standard Results
Mondi, 2005, # [31] Trauma ICU, 39 pts TA (104) & (105) BAL (105) • TA (104): sens = 95%, spec = 58%, k = 0.5339 (p < 0.0001).
• TA (105): sens = 90%, spec = 68%, k = 0.6384 (p < 0.0001).
Brun-Buisson, 2005, ** [32] Mixed ICU, 68 pts TA (score ≥4+) & bPTC (103) & PTC (103) BAL (104 or ICO > 2%) • TA: sens = 77%, spec = 81%.
• bPTC: sens = 77%, spec = 97%.
• PTC: sens = 77%, spec = 94%.
Davis, 2005, # [42] Trauma ICU, 155 pts Gram (BAL) CDC + BAL (105) • Gram (BAL): sens = 88% (any organism).
• Gram (BAL): sens = 73%, spec = 49%; PPV = 78%, NPV = 42%, accuracy = 65% (Gram-negative).
• Gram (BAL): sens = 87%, spec = 59%; PPV = 68%, NPV = 83%, accuracy = 74% (Gram-positive).
Croce, 2004, ** [43] Trauma ICU, 526 pts BAL (104 & 105) BAL (105) and ClEvol • BAL (105): sens = 95%, spec = 10%.
• BAL (104): sens = 99%, spec = 70%.
Miller, 2003, ** [44] Trauma ICU, 168 pts BAL (102 to 104) BAL (105) • BAL (104 and 103): increased sensitivity = 14%.
• BAL (102): increased sensitivity = 16%.
Sirvent, 2003, ** [45] Mixed ICU, 82 pts ICO Mini-BAL (103) • ICO ≥ 2%: sens = 80%, spec = 82%.
• ICO ≥ 2% better than 1, 5, 7 and 10%.
Wu, 2002, ** [35] Medical ICU, 48 pts TA (105) PSB (103) or BAL (104) • TA and PSB: sens = 91%, spec = 72%; PPV = 75%, NPV = 90%.
• TA and BAL: sens = 91%, spec = 75%; PPV = 78%, NPV = 90%.
Duflo, 2001, ** [46] Mixed ICU, 104 pts Gram stain (mini-BAL) Mini-BAL (103) • Gram stain: sens = 76%, spec = 100%, k = 0.73, concordance = 86%.
Prekates, 1998,*, ** [47]    BAL • Gram stain: sens = 77%, spec = 87%, PPV = 71%, NPV = 90%.
Bello, 1996, *, ** [48] ICU, 74 pts, consecutive Mini-PSB PSB and BAL • BAL and PSB: concordance = 92%.
• mini-PSB and BAL: concordance = 84%.
• mini-PSB and PSB: concordance = 85%.
Pugin, 1991, ** [16] Surgical ICU, 28 pts, CPIS & mini-BAL (BI ≥ 5) BAL (BI ≥ 5) • CPIS: sens = 93%, spec = 100%, r = 84% (CIPS and mini-BAL), r = 76% (CPIS and BAL).
• Mini-BAL: sens = 73%, spec = 96%.
Jourdain, 1995, ** [36] Mixed ICU, 39 pts TA (103 to 107) PSB (103) and ICO (≥ 5%) • TA (103): sens = 90%, spec = 26%, accuracy = 47%.
• TA (104): sens = 84%, spec = 40, accuracy = 54%.
• TA (105): sens = 79%, spec = 66%, accuracy = 70%.
• TA (106): sens = 68%, spec = 84%, accuracy = 79%, correlation = 40% (TA and PSB).
• TA (107): sens = 21%, spec = 92%, accuracy = 68%.
Marik, 1995, ** [37] Medical ICU, 53 pts Mini-PSB (103) PSB (103) • Mini-PSB and PSB: quantitative agreement = 85%.
Kollef, 1995, # [38] Medical ICU, 42 pts Mini-BAL (103) & PSB (103) Johanson (ATS) • Mini-BAL: sens = 100%, spec = 95%.
• PSB: sens = 71%, spec = 100%. Good agreement between mini-BAL and PSB cultures: k = 0,63, concordance = 83%.
Rumbak, 1994, # [39] Mixed ICU, 38 pts TA PSB (103) • TA: sens = 97%, spec = 50%, PPV = 91%, NPV = 80%.
Valles, 1994, ** [49] Mixed ICU, 42 pts ICO & BAL Clinical criteria + PSB (103) • BAL (103): sens = 89%, spec = 79%, PPV = 76%, NPV = 90%.
• BAL (104): sens = 89%, spec = 100%, PPV = 100%, NPV = 92%.
• ICO (≥ 2%): = 78%, spec = 88%, PPV = 82%, NPV = 84%.
• ICO (≥ 5%): = 67%, spec = 96%, PPV = 92%, NPV = 79%.
• ICO (≥ 7%): = 67%, spec = 100%, PPV = 100, NPV = 80%.
• ICO for Pseudomonas: lower sens.
• Previous antibiotic treatment decreased sens.
El-Ebiary, 1993, ** [40] Medical ICU, 102 pts TA, PSB and BAL Clinical ad hoc • TA (105): sens = 70%, spec = 72%, accuracy = 71%.
• PSB (103): sens = 60%, spec = 93, accuracy = 64%.
• BAL (104): sens = 57%, spec = 87%, accuracy = 67%.
Elatrous, 2004, ** [33] Medical ICU, 100 pts, TA (102 to 106) PTC (106) • TA (102): sens = 96%, spec = 66%.
• TA (103): sens = 94%, spec = 66%.
• TA (104): sens = 92%, spec = 85%, k = 0,78.
• TA (105): sens = 84%, spec = 90%.
• TA (106): sens = 44%, spec = 94%.
Mimoz, 2000, ** [50] Mixed ICU, 134 pts, Gram stain (10 and 50 fields) PSB (103) or bPTC (103) • Gram (10 fields) vs PSB: sens = 74%, spec = 94%.
• Gram (10 fields) vs PTC: sens = 81%, spec = 100%.
• PSB: correlation between morphology and culture: sens = 54%, spec = 86%.
• bPTC: correlation between morphology and culture: sens = 69% and spec = 89%.
Flanagan, 2000, ** [22] Mixed ICU, 145 pts, Mini-BAL (104) & BAL (104) & PSB (103) & CPIS & BI (≥5) Clinical (modified CDC) • Mini-BAL: sens = 74%, spec = 70%, PPV = 17%, NPV = 96%.
• BAL: sens = 76%, spec = 71%, PPV = 35%, NPV = 93%.
• PSB: sens = 68%, spec = 86%, PPV = 54%, NPV = 95%.
• CPIS > 7: sens = 85%, spec = 91%, PPV = 61%, NPV = 96%.
• BI: sens = 62%, spec = 53%.
Allaouchiche, 1999, ** [51] Mixed ICU, 118 pts, ICO (≥ 2%) & Gram stain (BAL) PSB (103) • ICO: sens = 86%, spec = 78%, PPV = 68%, NPV = 91%, k = 0.616, concordance = 81.5%.
• Gram stain: sens = 90%, spec = 73%, PPV = 64%, NPV = 91%, k = 0.58, concordance = 79.4%.
• Correlation between morphology and culture: complete = 51%, partial = 39.2%, no correlation = 9.8%.
Casetta, 1999, ** [53] Mixed ICU (Cancer), 42 pts PTC (103) PSB (103) • PTC: sens = 67%, spec = 93%; PPV = 71%, NPV = 91%, agreement = 87%.
Souweine, 1998, ** [54] Mixed ICU, 52 pts Antibiotic use & ICO (≥ 5%), PSB (103) & BAL (105) Clin ad hoc • ICO: sens = 71% (no antibiotics), 50% (current antibiotics), 67% (recent antibiotics).
• PSB: sens = 88% (no antibiotics), 77% (current antibiotics), 40% (recent antibiotics).
• BAL: sens = 71% (no antibiotics), 83% (current antibiotics), 38% (recent antibiotics).
Allaouchiche, 1996, ** [52] Mixed ICU, 132 pts ICO PSB (103) + clinical evolution • ICO (≥ 2%): sens = 84%, spec = 80%, PPV = 69%, NPV = 90%, ROC = 0.888.
Barreiro, 1996, ** [55] Mixed ICU, 93 pts pBAL (104) & Gram stain & ICO (≥ 2%) PSB (103) + Follow-up • pBAL: sens = 87%, spec = 91%, PPV = 87%, NPV = 91%.
• ICO: sens = 75%, spec = 98%, PPV = 96%, NPV = 86%.
Torres, 1989, ** [41] Mixed ICU, 34 pts BAL & BI PTC & BI • BAL: spec = 71%, r = 0,72 (between BAL and BI)
• PTC: spec = 86%, r = 0.78 (between PTC and BI)
Timsit, 1993, ** [56] Mixed ICU, 26 pts PSB 1 PSB 2 (2 minutes interval) • PSB 1: sens = 67%, spec = 94%.
• PSB 2: sens = 54%, spec = 94%.
Gerbeaux, 1998, ** [57] Mixed ICU, 44 pts BAL 1 BAL 2 (30 minutes interval) • BAL 1-BAL2 repeatability = 75% with no bias, agreement = 47%.
Butler, 2004, ** [58] Surgical ICU, 34 pts Blind PSB Directed PSB • Blind PSB and Directed PSB: concordance = 53%.
Wood, 2003, ** [34] Trauma ICU, 90 pts TA & BDPB & BPB & BAL BDPB & BAL • TA & BAL: k = 0.535.
• BPB & BDPB: k = 0.467.
• BPB & BAL: k = 0.547.
  1. ICU = intensive care unit; TA = tracheal aspiration; BAL = bronchoalveolar lavage; sens = sensitivity; spec = specificity; bPTC = blinded protected telescoping catheter; PTC = protected (plugged) telescoping catheter; ICO = intracellular organism; CDC = center for disease control; PPV = positive predictive value; NPV = negative predictive value; ClEvol: clinical evolution; PSB = protected specimen brush; CPIS = clinical pulmonary infection score; BI = bacterial index; ATS = American Toracic Society; vs = versus; BDPB = bronchoscope-directed protected brushings; BPB = blind protected brushing via endotracheal tube; *retrospective; **consecutive; #convenient.