Is bilateral protected specimen brush sampling necessary for the accurate diagnosis of ventilator-associated pneumonia?
BACKGROUND
Clinical acumen alone is unreliable in establishing a diagnosis of ventilator-associated pneumonia (VAP) and controversy exists over which diagnostic tools should be utilized to confirm a clinical suspicion of VAP. The purpose of this study was to determine the reliability of blind protected specimen brush (PSB) sampling in the diagnosis of VAP and if bilateral PSB sampling is necessary.


METHODS
Prospective study comparing blind PSB sampling with bronchoscopic directed PSB sampling in thirty-four consecutive SICU patients with a clinical suspicion of VAP. All patients underwent blind PSB sampling followed by bronchoscopic directed contralateral PSB sampling.


RESULTS
Twenty-four of 34 patients (71%) were diagnosed to have VAP. The concordance rate between blind and directed PSB samples was 53% (18/34). When blind PSB was positive (15/34), the contralateral sample yielded a different microorganism in three patients (9%). When blind PSB was negative (19/34), infection was present in the contralateral lung in nine patients (26%). Blind PSB sampling alone was inaccurate in 35% of patients.


CONCLUSIONS
The low concordance between blind and directed PSB suggests the need to sample both lung fields. Bilateral PSB sampling can identify unsuspected pathogenic microorganisms in the contralateral lung.
Butler
Karyn L
KL
Morehouse School of Medicine, Department of Surgery, Atlanta, Georgia 30310, USA. butlerk@msm.edu
Best
Irwin M
IM
Oster
Robert A
RA
Katon-Benitez
Iva
I
Lynn Weaver
Wm
W
Bumpers
Harvey L
HL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000191:economics / Q000379:methods* / Q000592:standards; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy / Q000191:economics / Q000379:methods* / Q000592:standards; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005334:Fever / Q000382:microbiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D007964:Leukocytosis / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000209:etiology; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000191:economics / Q000379:methods* / Q000592:standards; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications