[Value of blinded sampling methods in the pathogenic diagnosis of ventilator-associated pneumonia].
OBJECTIVE
To evaluate the diagnostic value of blinded protected specimen brush and quantitative culture (BPSB-QC) in the pathogenic diagnosis of ventilator-associated pneumonia (VAP).


METHODS
A prospective, self-controlled clinical trial was conducted during a 36-month period. QC of paired samples of BPSB and PSB via a fiberoptic bronchoscopy (FOB- PSB) in a total of 54 patients during 125 suspected episodes of VAP was compared. The sensitivity and accuracy, as well as the concordance between BPSB-QC and FOB-PSB-QC result in 48 patients with 106 episodes of VAP were assessed. Both BPSB-QC and FOB-PSB-QC greater than 103 cfu/ml (positive cutoff) was considered diagnostic of VAP.


RESULTS
Forty-eight patients with 106 episodes were considered to have VAP (84.8%). The accuracy of BPSB-QC and FOB-PSB-QC were 80.8% (101/125) and 83.2% (104/125), respectively. The rate of complete concordant results was high (75.2%) for BPSB-QC and FOB-PSB-QC. The pathogenic diagnostic agreement between the two techniques was 84.8% (106/125). There were no significant differences with regard to site of pneumonia and positive diagnostic rate between the two techniques.


CONCLUSIONS
BPSB-QC has similar accuracy and same feasibility compared with FOB-PSB-QC which was commonly primarily used in the pathogenic diagnosis of VAP, and that its use is substantially simpler, safe and cost saving, especially when FOB technique is not available.
Department of Geriatric-Respriatory, General Hospital of PLA, Beijing 100853, China. caish@301hospital.com.cn
Shao-Hua
SH
Cai
Sen-Yang
SY
Yu
Jin-Chuan
JC
Zhang
Chang-Ting
CT
Liu
Gui-Sheng
GS
Qian
D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D001999:Bronchoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000382:microbiology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity