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Research ArticleOriginal Research

Comparison of Semi-Quantitative Endotracheal Aspirates to Quantitative Non-Bronchoscopic Bronchoalveolar Lavage in Diagnosing Ventilator-Associated Pneumonia

Shigeki Fujitani, Mark H Cohen-Melamed, Raymond P Tuttle, Edgar Delgado, Yasuhiko Taira and Joseph M Darby
Respiratory Care November 2009, 54 (11) 1453-1461;
Shigeki Fujitani
Department of Critical Care,University of Pittsburgh, Pittsburgh, Pennsylvania, and with the Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kanagawa, Japan.
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  • For correspondence: [email protected]
Mark H Cohen-Melamed
Department of Respiratory Care, University of Pittsburgh Medical Center Presbyterian University Hospital, Pittsburgh, Pennsylvania.
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Raymond P Tuttle
Department of Respiratory Care, University of Pittsburgh Medical Center Presbyterian University Hospital, Pittsburgh, Pennsylvania.
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Edgar Delgado
Department of Respiratory Care, University of Pittsburgh Medical Center Presbyterian University Hospital, Pittsburgh, Pennsylvania.
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Yasuhiko Taira
Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki City, Kanagawa, Japan.
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Joseph M Darby
Department of Critical Care, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Abstract

BACKGROUND: Current strategies for diagnosing ventilator-associated pneumonia (VAP) favor the use of quantitative methods; however, semi-quantitative cultures of endotracheal aspirates are still commonly used.

METHODS: The microbiological results of patients with suspected VAP who had both quantitative cultures with non-bronchoscopic bronchoalveolar lavage (BAL) and semi-quantitative cultures of endotracheal aspirate obtained within 24 hours of each other were retrospectively reviewed and compared, using a quantitative threshold of ≥ 104 colony-forming units/mL as a reference standard.

RESULTS: 256 patients with paired cultures were identified. Concordance between endotracheal aspirate (any growth of pathogens) and non-bronchoscopic BAL was complete in 58.2% and completely discordant in 23.8%. The sensitivity and specificity of endotracheal aspirate were 65.4% and 56.1%, which improved to 81.2% and 61.9% when antibiotic management decisions were considered in the analysis. Twenty-six patients had endotracheal aspirate cultures that were falsely negative for pathogens, with 61.5% of these patients demonstrating growth of non-fermenting Gram-negative rods or methicillin-resistant Staphylococcus aureus (MRSA) on non-bronchoscopic BAL. Overall, 45 patients (17.5%) among the entire cohort had false positive endotracheal aspirate cultures, with 19 of these patients (42.2%) demonstrating growth of non-fermenting Gram-negative rods or MRSA.

CONCLUSIONS: Semi-quantitative cultures of endotracheal aspirate are poorly concordant with quantitative cultures obtained via non-bronchoscopic BAL. Although the performance of endotracheal aspirate improves when antibiotic treatment is considered, guiding therapy on the basis of semi-quantitative cultures may still result in failure to identify potentially multiple-drug-resistant pathogens, and would also tend to promote excessive antibiotic usage. Our data support the use of quantitative cultures in diagnosing VAP.

  • ventilator-associated pneumonia
  • endotracheal aspirate
  • non-bronchoscopic bronchoalveolar lavage
  • quantitative culture
  • semi-quantitative culture

Footnotes

  • Correspondence: Shigeki Fujitani MD, Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, Japan 216-8511. E-mail: shigekifujitani{at}hotmail.com.
  • The authors have disclosed no conflicts of interest.

  • Copyright © 2009 by Daedalus Enterprises Inc.
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Respiratory Care: 54 (11)
Respiratory Care
Vol. 54, Issue 11
1 Nov 2009
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Comparison of Semi-Quantitative Endotracheal Aspirates to Quantitative Non-Bronchoscopic Bronchoalveolar Lavage in Diagnosing Ventilator-Associated Pneumonia
Shigeki Fujitani, Mark H Cohen-Melamed, Raymond P Tuttle, Edgar Delgado, Yasuhiko Taira, Joseph M Darby
Respiratory Care Nov 2009, 54 (11) 1453-1461;

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Comparison of Semi-Quantitative Endotracheal Aspirates to Quantitative Non-Bronchoscopic Bronchoalveolar Lavage in Diagnosing Ventilator-Associated Pneumonia
Shigeki Fujitani, Mark H Cohen-Melamed, Raymond P Tuttle, Edgar Delgado, Yasuhiko Taira, Joseph M Darby
Respiratory Care Nov 2009, 54 (11) 1453-1461;
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Keywords

  • ventilator-associated pneumonia
  • endotracheal aspirate
  • non-bronchoscopic bronchoalveolar lavage
  • quantitative culture
  • semi-quantitative culture

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