[Quantitative culture sampling of tracheal aspirates for diagnosis of nosocomial pneumonia in the ITU].
BACKGROUND
Nosocomial pneumonia is defined as a pneumonia developing within 48 hours of admission, in a patient with previously normal lung tissue. Ventilator-associated pneumonia (VAP) due to migration of microorganisms from the nose, throat and digestive tract is typical in ITU patients. Microbiological diagnosis is difficult, and there is no single method approved for VAP diagnosis. We have assessed the usefulness of Quantitative Endotracheal Aspirate (QETA) for this purpose, basing on its reported high sensitivity (mean 76% +/- 9%) and specificity (mean 75 +/- 28%).


METHODS
Endotracheal aspirates were sampled from ITU patients fulfilling the following criteria: (1) New or progressive infiltrations in the lungs plus hyperthermia (>38.3 degrees C) or hypothermia (<36 degrees C); (2) leukocytosis (>12 G L(-1)) or leukopenia (<4 G L(-1)); or (3) purulent sputum.


RESULTS
Nosocomial pneumonia was diagnosed in 40 out of 312 patients treated in the ITU during the study period. VAP was diagnosed in 33 patients. Multi-drug resistant bacteria: Pseudomonas aeruginosa (16), Acinetobacter baumannii (19), ESBL pathogens (8) and MRSA (1) were cultured from QETA in 32 patients. The sensitivity of QETA was 86%.


CONCLUSIONS
The results allowed for early and accurate diagnosis of nosocomial pneumonia and institution of the best possible treatment.
Zeliaś
Aleksander
A
Oddział Intensywnej Terapii i Anestezjologii WSzS w Krakowie.
Budak
Alicja
A
Włodarczyk
Dorota
D
Wodziński
Paweł
P
D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D003428:Cross Infection / Q000175:diagnosis* / Q000382:microbiology* / Q000401:mortality; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000382:microbiology*; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000382:microbiology; D011044:Poland; D012121:Respiration, Artificial / Q000009:adverse effects; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014132:Trachea / Q000382:microbiology*