Document Detail

Diagnostic accuracy of protected specimen brush and bronchoalveolar lavage in nosocomial pneumonia: impact of previous antimicrobial treatments.
MedLine Citation:
PMID:  9468159     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine whether the diagnostic accuracy of bronchoscopy samples in patients with suspected ventilator-associated pneumonia is affected by prior antibiotic treatment given for a previous infection, and/or by antibiotic treatment recently started to treat suspected ventilator-associated pneumonia. DESIGN: Study of critically ill patients. SETTING: Intensive care unit in a university hospital. PATIENTS: Sixty-three episodes of suspected ventilator-associated pneumonia were prospectively evaluated. Based on prior antibiotic treatment, three groups were defined: no antibiotic group (no previous antibiotic treatments), n = 12; current antibiotic group (antibiotic treatment initiated >72 hrs earlier), n = 31; and recent antibiotic group (new antibiotic treatment class started within the last 24 hrs), n = 20. INTERVENTIONS: Fiberoptic bronchoscopy with quantitative protected specimen brush cultures, bronchoalveolar lavage cultures, and intracellular organism counts of bronchoalveolar lavage cells. MEASUREMENTS AND MAIN RESULTS: The diagnosis of ventilator-associated pneumonia was made in 35 cases, based on histology (n = 2), cavitation (n = 2), blood cultures (n = 4), or outcome under appropriate antibiotic treatment (n = 27). The discriminative value of the tests, based on the area under the receiver operating characteristic curve, was high (> or =0.85) in both current antibiotic treatment and recent antibiotic treatment patients. Sensitivities for a 5% intracellular organism count of bronchoalveolar lavage cells, a protected specimen brush culture threshold of 10(3) colony-forming units (cfu)/mL, and a bronchoalveolar lavage culture threshold of 10(5) cfu/mL were as follows, respectively, in the three groups: 0.71, 0.88, and 0.71 (no antibiotic treatment group); 0.5, 0.77, and 0.83 (current antibiotic group); and 0.67, 0.40, and 0.38 (recent antibiotic group). Specificity was consistently > or =0.9. In the recent antibiotic group, protected specimen brush and bronchoalveolar lavage cultures had lower sensitivities (p < .05), and the best threshold values for these two tests were 10(2) cfu/mL and 10(3) cfu/mL, respectively. CONCLUSIONS: After recent introduction of an antibiotic treatment for suspected ventilator-associated pneumonia, protected specimen brush and bronchoalveolar lavage culture thresholds must be decreased to maintain good accuracy. In contrast, current antibiotic treatment prescribed for a prior infectious disease does not modify the diagnostic accuracy of protected specimen brush or bronchoalveolar lavage.
B Souweine; B Veber; J P Bedos; B Gachot; M C Dombret; B Regnier; M Wolff
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  26     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  1998 Feb 
Date Detail:
Created Date:  1998-02-26     Completed Date:  1998-02-26     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  236-44     Citation Subset:  AIM; IM    
Service de Réanimation des Maladies Infectieuses, Groupe Hospitalier Bichat-Claude Bernard, Paris, France.
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MeSH Terms
Anti-Bacterial Agents / therapeutic use*
Bronchoalveolar Lavage / instrumentation,  methods,  statistics & numerical data
Bronchoalveolar Lavage Fluid / microbiology*
Bronchoscopy / methods,  statistics & numerical data
Colony Count, Microbial
Critical Illness
Cross Infection / drug therapy,  etiology,  microbiology*
Middle Aged
Pneumonia, Bacterial / drug therapy,  etiology,  microbiology*
Prospective Studies
Specimen Handling / instrumentation,  methods*,  statistics & numerical data
Treatment Outcome
Ventilators, Mechanical / adverse effects
Reg. No./Substance:
0/Anti-Bacterial Agents
Comment In:
Crit Care Med. 1998 Feb;26(2):198-9   [PMID:  9468146 ]

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