title: Quantitative tracheal lavage versus bronchoscopic protected specimen brush for the diagnosis of nosocomial pneumonia in mechanically ventilated patients.
abstract: BACKGROUND
  No gold standard method exists for the diagnosis of ventilator-associated pneumonia despite the availability of multiple techniques.
  
  
  METHODS
  A prospective, crossover study was performed on mechanically ventilated patients meeting with suspected pneumonia. Eighteen paired samples were obtained on 15 patients, comparing the results of quantitative tracheal lavage (QTL) to bronchoscopic protected brush specimen (PSB) by quantitative culture and gram stain examination.
  
  
  RESULTS
  The sensitivity, specificity, positive and negative predictive values, and accuracy are affected by the growth density threshold selected, and whether the same organisms are expected by both methods. There is a significant relationship between QTL and PSB (P = 0.0048; R = 0.632), gram stain and PSB (P <0.001; R = 0.791), and gram stain and QTL (P = 0.0125; R = 0.575), by Spearman rank order correlation.
  
  
  CONCLUSIONS
  QTL may have a role for diagnosing and directing treatment of ventilator-associated pneumonia, allowing reservation of bronchoscopic PSB for secondary, high risk and refractory cases.
authors.affiliation: Division of General Surgery, Trauma and Critical Care, Department of Surgery, University of Missouri-Columbia, Columbia, MO 65212, USA. AucarJ@health.missouri.edu
authors.forename: John A
authors.initials: JA
authors.lastname: Aucar
authors.forename: Miguel
authors.initials: M
authors.lastname: Bongera
authors.forename: Jeffrey O
authors.initials: JO
authors.lastname: Phillips
authors.forename: Ravishankar
authors.initials: R
authors.lastname: Kamath
authors.forename: Michael H
authors.initials: MH
authors.lastname: Metzler
mesh_terms: D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy; D016022:Case-Control Studies; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000175:diagnosis* / Q000209:etiology; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012680:Sensitivity and Specificity; D014132:Trachea / Q000382:microbiology*