title: Stable patients receiving prolonged mechanical ventilation have a high alveolar burden of bacteria.
abstract: BACKGROUND
  In patients receiving prolonged mechanical ventilation (PMV), quantitative bronchoscopic culture has not been validated for the diagnosis of ventilator-associated pneumonia (VAP).
  
  
  OBJECTIVE
  To measure the alveolar burden of bacteria in patients receiving PMV.
  
  
  METHODS
  Respiratory care units of a university hospital and a long-term care facility.
  
  
  METHODS
  Fourteen patients requiring PMV without clinical evidence of pneumonia.
  
  
  METHODS
  Quantitative culture of BAL from the right middle lobe and lingula.
  
  
  RESULTS
  In 29 of 32 lobes, there was growth of at least one organism at > 10(4) cfu/mL. Most lobes had polymicrobial growth.
  
  
  CONCLUSIONS
  Stable patients receiving PMV without clinical pneumonia have a high alveolar burden of bacteria. The bacterial burden in most patients exceeds the commonly accepted threshold for diagnosing VAP. The utility of quantitative bronchoscopic culture in the diagnosis of VAP in this patient population requires further study.
authors.affiliation: Division of Pulmonary/Critical Care Medicine, T-17 Room 040 HSC, Stony Brook University, Stony Brook, NY 11794-8172, USA. dbaram@notes.cc.sunysb.edu
authors.forename: Daniel
authors.initials: D
authors.lastname: Baram
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Hulse
authors.forename: Lucy B
authors.initials: LB
authors.lastname: Palmer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification*; D015169:Colony Count, Microbial; D006801:Humans; D008875:Middle Aged; D011650:Pulmonary Alveoli / Q000382:microbiology*; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy*; D013997:Time Factors