title: Diagnosis of ventilator-associated pneumonia: agreement between quantitative cultures of endotracheal aspiration and plugged telescoping catheter.
abstract: OBJECTIVE
  To evaluate the diagnostic agreement between quantitative cultures of samples obtained with endotracheal aspiration (ETA) and plugged telescoping catheter (PTC).
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Medical ICU.
  
  
  METHODS
  Hundred thirty-eight episodes of suspected ventilator-associated pneumonia studied in 100 consecutive patients.
  
  
  METHODS
  For each suspected episode of ventilator-associated pneumonia, ETA and PTC were performed consecutively. The agreement between microbiological results obtained from the two techniques was evaluated (kappa statistic test). Pneumonia was diagnosed on a positive culture result of telescoping catheter with the threshold set at 10(3) cfu/ml or more. The cut-off points evaluated for ETA ranged from 10(2 )to 10(6) cfu/ml.
  
  
  RESULTS
  Micro-organisms retrieved by aspiration and telescoping catheter were similar and bacterial counts obtained by the two procedures were well correlated ( r = 0.71 p < 0.001). There was good agreement between positive and negative ETA and PTC specimens (kappa: 0.78) with a diagnostic threshold for ETA of 10(4) cfu/ml. The sensitivity and specificity of ETA for the diagnosis of PTC-confirmed pneumonia were 92% and 85%, respectively. Kappa decreased to 0.48 when the diagnostic threshold was increased to 10(6) cfu/ml.
  
  
  CONCLUSIONS
  Quantitative cultures of ETA and PTC tallied for both micro-organisms and counts. The simpler ETA appears adequate for determining the presence of pathogenic organisms in significant concentration in the lower respiratory tract.
authors.affiliation: Intensive Care Unit, Centre Hospitalo-Universitaire F. Bourguiba, 5000 Monastir, Tunisia.
authors.forename: Souheil
authors.initials: S
authors.lastname: Elatrous
authors.forename: Riadh
authors.initials: R
authors.lastname: Boukef
authors.forename: Lamia
authors.initials: L
authors.lastname: Ouanes Besbes
authors.forename: Soudani
authors.initials: S
authors.lastname: Marghli
authors.forename: Sami
authors.initials: S
authors.lastname: Nooman
authors.forename: Semir
authors.initials: S
authors.lastname: Nouira
authors.forename: Fekri
authors.initials: F
authors.lastname: Abroug
mesh_terms: D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D002404:Catheterization / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012121:Respiration, Artificial / Q000009:adverse effects*; D013048:Specimen Handling / Q000295:instrumentation / Q000379:methods*