Ventilator associated pneumonia: comparison between quantitative and qualitative cultures of tracheal aspirates.
BACKGROUND
Deferred or inappropriate antibiotic treatment in ventilator-associated pneumonia (VAP) is associated with increased mortality, and clinical and radiological criteria are frequently employed to establish an early diagnosis. Culture results are used to confirm the clinical diagnosis and to adjust or sometimes withdraw antibiotic treatment. Tracheal aspirates have been shown to be useful for these purposes. Nonetheless, little is known about the usefulness of quantitative findings in tracheal secretions for diagnosing VAP.


METHODS
To determine the value of quantification of bacterial colonies in tracheal aspirates for diagnosing VAP, we conducted a prospective follow-up study of 106 intensive care unit patients who were under ventilatory support. In total, the findings from 219 sequential weekly evaluations for VAP were examined. Clinical and radiological parameters were recorded and evaluated by three independent experts; a diagnosis of VAP required the agreement of at least two of the three experts. At the same time, cultures of tracheal aspirates were analyzed qualitatively and quantitatively (10(5) colony-forming units [cfu]/ml and 10(6) cfu/ml)


RESULTS
Quantitative cultures of tracheal aspirates (10(5) cfu/ml and 10(6) cfu/ml) exhibited increased specificity (48% and 78%, respectively) over qualitative cultures (23%), but decreased sensitivity (26% and 65%, respectively) as compared with the qualitative findings (81%). Quantification did not improve the ability to predict a diagnosis of VAP.


CONCLUSIONS
Quantitative cultures of tracheal aspirates in selected critically ill patients have decreased sensitivity when compared with qualitative results, and they should not replace the latter to confirm a clinical diagnosis of VAP or to adjust antimicrobial therapy.
Camargo
Luis Fernando Aranha
LF
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brasil. luis_camargo@einstein.com.br
De Marco
Fernando Vinícius
FV
Barbas
Carmen Sílvia Valente
CS
Hoelz
Cristiane
C
Bueno
Marco Aurélio Scarpinella
MA
Rodrigues
Milton
M
Amado
Verônica Moreira
VM
Caserta
Raquel
R
Martino
Marinês Dalla Valle
MD
Pasternak
Jacyr
J
Knobel
Elias
E
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001431:Bacteriological Techniques; D001938:Brazil; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D015169:Colony Count, Microbial; D016638:Critical Illness; D003428:Cross Infection / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D003430:Cross-Sectional Studies; D017723:Drug Utilization Review; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012680:Sensitivity and Specificity; D014132:Trachea / Q000378:metabolism / Q000382:microbiology
D000900:Anti-Bacterial Agents