Diagnosis of ventilator-associated pneumonia: agreement between quantitative cultures of endotracheal aspiration and plugged telescoping catheter.
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.
Elatrous
Souheil
S
Intensive Care Unit, Centre Hospitalo-Universitaire F. Bourguiba, 5000 Monastir, Tunisia.
Boukef
Riadh
R
Ouanes Besbes
Lamia
L
Marghli
Soudani
S
Nooman
Sami
S
Nouira
Semir
S
Abroug
Fekri
F
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*