title: Bronchoscopy in ventilator-associated pneumonia: agreement of calibrated loop and serial dilution.
abstract: BACKGROUND
  Although the serial dilution technique for quantitative culture of bronchoalveolar fluid is considered to be the gold standard for the diagnosis of ventilator-associated pneumonia, it is more labor intensive than the calibrated loop technique.
  
  
  OBJECTIVE
  We sought to determine the agreement between the calibrated loop and serial dilution techniques in the diagnosis of ventilator-associated pneumonia.
  
  
  METHODS
  We prospectively measured bacterial colony counts by the serial dilution and calibrated loop techniques in 121 bronchoalveolar lavage samples of 104 patients with suspected ventilator-associated pneumonia.
  
  
  RESULTS
  At the time of bronchoscopy, patients had received mechanical ventilation for a median of 8 d. Patients were receiving antibiotics when 90 of the 121 (74.4%) bronchoalveolar samples were obtained. The colony counts of 13 bacterial isolates were too numerous to count by the calibrated loop technique; by serial dilution technique, their counts ranged from 4.70 to 6.74 log10 cfu/ml. Fifty other bacteria had paired colony counts measured by each of the two techniques: the bias (95% confidence interval) between the two techniques was -0.380 (-0.665 to -0.095) log10 cfu/ml, with precision of 1.002 log10 cfu/ml and 95% limits of agreement of -2.344 to 1.584 log10 cfu/ml. Using the threshold of 4 log10 cfu/ml as a criterion for the diagnosis of ventilator-associated pneumonia, there was discordance only for one bacterial organism between the two techniques.
  
  
  CONCLUSIONS
  The calibrated loop technique can be used for the diagnosis of ventilator-associated pneumonia using bronchoalveolar lavage fluid.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. afessa.bekele@mayo.edu
authors.forename: Bekele
authors.initials: B
authors.lastname: Afessa
authors.forename: Rolf D
authors.initials: RD
authors.lastname: Hubmayr
authors.forename: Emily A
authors.initials: EA
authors.lastname: Vetter
authors.forename: Mark T
authors.initials: MT
authors.lastname: Keegan
authors.forename: Karen L
authors.initials: KL
authors.lastname: Swanson
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.forename: Franklin R
authors.initials: FR
authors.lastname: Cockerill
authors.forename: Steve G
authors.initials: SG
authors.lastname: Peters
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D001999:Bronchoscopy; D002138:Calibration; D015169:Colony Count, Microbial / Q000379:methods*; D005260:Female; D006801:Humans; D007201:Indicator Dilution Techniques; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012121:Respiration, Artificial / Q000009:adverse effects*; D012680:Sensitivity and Specificity; D013211:Staphylococcus aureus / Q000302:isolation & purification; D020615:Stenotrophomonas maltophilia / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents