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Table 6 Studies comparing cytological examination to quantitative cultures

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

First author Sample Dx tests Gold standard Results
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).
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%.
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%.
Mimoz, 2000, ** [50] Mixed ICU, 134 pts Gram stain (10 and 50 fields) PSB (103) or bPTC (103) • Gram stain (10 fields) vs PSB: sens = 74%, spec = 94%.
• Gram stain (10 fields) vs PTC: sens = 81%, spec = 100%.
• Gram (50 fields): slight increase in spec, decrease in sens
• Morphology and PSB culture: sens = 54%, spec = 86%.
• Morpholgy and bPTC culture: sens = 69%, spec = 89%.
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.%, no correlation: 9.8%.
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.
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 = 83%.
• Mini-BAL: sens = 22%, spec = 100%.
• BAL: sens = 45%, spec = 55%.
Sole-Violan, 1994, ** [68] Mixed ICU, 33 pts ICO (BAL) & BAL (104) & PSB (103) Clinical ad hoc • BAL: sens = 87%, spec = 100%.
• PSB: sens = 75%, spec = 100%.
• ICO (>4%): sens = 62%, spec = 100%.
Brasel, 2003, ** [66] Surgical ICU, 35 pts ICO 5% & ICO 7% TA (104) & TA (105) • ICO 5% and TA (104): sens = 61%, spec = 89%, PPV = 90%, NPV = 59%, ROC = 0.84.
• ICO 5% and TA (105): sens = 85%, spec = 82%, PPV = 70%, NPV = 91%, ROC = 0.89.
• ICO 7% and TA (104): sens = 39%, spec = 97%, PPV = 96%, NPV = 50%, ROC = 0.86.
• ICO 7% and TA (105): sens = 61%, spec = 91%, PPV = 77%, NPV = 82%, ROC = 0.84.
Timsit, 2001, ** [65] Mixed ICU, 110 pts BAL-D (1% of infected cells) BAL (104) & PSB (103) • BAL-D: sens = 93%, spec = 91%, AUC = 0.953, PPV = 90%, NPV = 98%.
Prekates, 1998, ** [47] Surgical and Trauma ICU, 75 pts, Gram stain (BAL) BAL • Gram stain: sens = 77%, spec = 87%, PPV = 71%, NPV = 90%.
  1. ICU = intensive care unit; BAL = bronchoalveolar lavage; CDC = center of disease control; sens = sensitivity; spec = specificity; PPV = positive predictive value; NPV = negative predictive value; ICO = intracellular organism; PSB = protected specimen brush; bPTC = blinded protected telescoping catheter; vs = versus; PTC = protected (plugged) telescoping catheter; TA = tracheal aspiration; BAL-D = direct examination of BAL; *retrospective; **consecutive; #convenient.