title: Quantitative culture of endotracheal aspirates in the diagnosis of ventilator-associated pneumonia in patients with treatment failure.
abstract: OBJECTIVE
  To study the correlation of bacteriology between quantitative cultures of protected specimen brush (PSB), BAL, and quantitative endotracheal aspirate (QEA) in ventilator-associated pneumonia (VAP) patients with treatment failure.
  
  
  METHODS
  Prospective observational clinical study.
  
  
  METHODS
  A 15-bed medical ICU of tertiary medical center.
  
  
  METHODS
  Forty-eight patients receiving mechanical ventilation with clinical suspected VAP who had been treated with antibiotics for at least 72 h without improvement.
  
  
  METHODS
  QEA, PSB, and BAL were performed with patients receiving antibiotics. The diagnostic thresholds for QEA, PSB, and BAL were 10(5), 10(3), and 10(4) cfu/mL, respectively.
  
  
  RESULTS
  Microbial culture findings were positive in 24 BAL samples (50%), in 23 PSB samples (48%), and in 28 QEA samples (58%). The correlations between of QEA vs PSB and QEA vs BAL were significant (rho = 0.567 and rho = 0.620, p < 0.01, respectively). The most commonly isolated microorganisms were Acinetobacter baumannii (27%), Staphylococcus aureus (24%), Stenotrophomonas maltophilia (15%), and Pseudomonas aeruginosa (10%). Using the predetermined criteria, bacterial pneumonia was diagnosed in 28 of 48 suspected VAP episodes based on PSB and/or BAL results. The diagnostic efficiency of QEA at threshold of 10(5) cfu/mL had a sensitivity of 92.8% and a specificity of 80%.
  
  
  CONCLUSIONS
  QEA correlated with PSB and BAL in patients with suspected VAP who responded poorly to the existent antibiotic treatment. QEA missed only two cases of bacterial pneumonia diagnosed by invasive PSB and/or BAL with acceptable sensitivity and specificity. More importantly, QEA is noninvasive and easily repeatable. Early use of QEA is helpful to clinical physicians in decision making with regard to antibiotics use.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mackay Memorial Hospital, Taipei, Taiwan. wuchienliang@sinamail.com
authors.forename: Chien Liang
authors.initials: CL
authors.lastname: Wu
authors.forename: Dine Ie
authors.initials: DIe
authors.lastname: Yang
authors.forename: Nai Yu
authors.initials: NY
authors.lastname: Wang
authors.forename: Hsu Tah
authors.initials: HT
authors.lastname: Kuo
authors.forename: Pai Zan
authors.initials: PZ
authors.lastname: Chen
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D014132:Trachea / Q000382:microbiology*; D017211:Treatment Failure; D012122:Ventilators, Mechanical / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents