title: Microbiogical data, but not procalcitonin improve the accuracy of the clinical pulmonary infection score.
abstract: OBJECTIVE
  Early and adequate treatment of ventilator-associated pneumonia (VAP) is mandatory to improve the outcome. The aim of this study was to evaluate, in medical ICU patients, the respective and combined impact of the Clinical Pulmonary Infection Score (CPIS), broncho-alveolar lavage (BAL) gram staining, endotracheal aspirate and a biomarker (procalcitonin) for the early diagnosis of VAP.
  
  
  METHODS
  Prospective, observational study
  
  
  METHODS
  A medical intensive care unit in a teaching hospital.
  
  
  METHODS
  Over an 8-month period, we prospectively included 57 patients suspected of having 86 episodes of VAP.
  
  
  METHODS
  The day of suspicion, a BAL as well as alveolar and serum procalcitonin determinations and evaluation of CPIS were performed.
  
  
  RESULTS
  Of 86 BAL performed, 48 were considered positive (cutoff of 10(4) cfu ml(-1)). We found no differences in alveolar or serum procalcitonin between VAP and non-VAP patients. Including procalcitonin in the CPIS score did not increase its accuracy (55%) for the diagnosis of VAP. The best tests to predict VAP were modified CPIS (threshold at 6) combined with microbiological data. Indeed, both routinely twice weekly performed endotracheal aspiration at a threshold of 10(5) cfu ml(-1) and BAL gram staining improved pre-test diagnostic accuracy of VAP (77 and 66%, respectively).
  
  
  CONCLUSIONS
  This study showed that alveolar procalcitonin performed by BAL does not help the clinician to identify VAP. It confirmed that serum procalcitonin is not an accurate marker of VAP. In contrast, microbiological resources available at the time of VAP suspicion (BAL gram staining, last available endotracheal aspirate) combined or not with CPIS are helpful in distinguishing VAP diagnosed by BAL from patients with a negative BAL.
authors.affiliation: Intensive Care Unit, Department of Anesthesiology and Critical Care B (DAR B), Centre Hospitalier Universitaire (CHU) Montpellier, INSERM ERI 25, Montpellier, France.
authors.forename: Boris
authors.initials: B
authors.lastname: Jung
authors.forename: Nathalie
authors.initials: N
authors.lastname: Embriaco
authors.forename: François
authors.initials: F
authors.lastname: Roux
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Forel
authors.forename: Didier
authors.initials: D
authors.lastname: Demory
authors.forename: Jérôme
authors.initials: J
authors.lastname: Allardet-Servent
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.forename: Bernard
authors.initials: B
authors.lastname: La Scola
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000097:blood* / Q000188:drug therapy / Q000382:microbiology*; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide