Utility of bilateral bronchoalveolar lavage for the diagnosis of ventilator-associated pneumonia in critically ill surgical patients.
BACKGROUND
Bronchoalveolar lavage (BAL) is recommended to facilitate the diagnosis of ventilator-associated pneumonia (VAP). It is unclear if bilateral sampling improves the accuracy of BAL.


METHODS
Consecutive patients with clinical suspicion for VAP were analyzed. All patients underwent bilateral BAL. A threshold of >10(4) colony-forming units (cfu)/mL was diagnostic for VAP (VAP positive). Samples were concordant if the organism(s) and thresholds from both lungs were diagnostically consistent. Organisms </=10(4) cfu/mL with growth on the contralateral sample >10(4) cfu/mL were considered false-negative samples.


RESULTS
Between November 2005 and April 2006, 73 patients were considered clinically suspicious for VAP. Forty-four (60%) patients were VAP positive. Twenty-eight (64%) VAP patients had concordant samples. Overall, there were 15 false-negative samples. Sole use of the unilateral samples to guide treatment would have inappropriately directed antibiotic avoidance and/or discontinuation in 25% of VAP patients. Influence of the chest radiograph was equivocal because of the presence of bilateral infiltrates in 80% of discordant samples.


CONCLUSIONS
Bilateral BAL improves the accuracy of bronchoscopy in diagnosing VAP. Unilateral BAL may be insensitive in patients with clinically significant contralateral infection.
Jackson
Sha-Ron
SR
Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, P.O. Box 670558, Cincinnati, OH 45264, USA.
Ernst
Neil E
NE
Mueller
Eric W
EW
Butler
Karyn L
KL
D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D015331:Cohort Studies; D015169:Colony Count, Microbial; D016638:Critical Illness; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011336:Probability; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013514:Surgical Procedures, Operative; D016019:Survival Analysis