title: Direct testing of bronchoalveolar lavages from ventilator-associated pneumonia patients.
abstract: In line with a rapid de-escalation of empirical antimicrobial therapy, this study assessed the validity of an E-test-based direct specimen testing method on bronchoalveolar lavage (BAL) samples from ventilator-associated pneumonia (VAP) patients. E-test strips were directly applied onto Mueller-Hinton agar plates seeded with BAL samples and read after 24 h of incubation. In parallel, the BAL samples were analyzed by the routine diagnostic laboratory. The microbroth dilution approach was used as a control method. In a cohort of 20 patients, 135 microorganism-antibiotic combinations were studied. Total agreement between the 2 methods was achieved for 88.9% combinations, with 1.5% very major errors (isolates susceptible by E-test and reported resistant by the diagnostic laboratory) and 9.6% major errors (isolates resistant by E-test and reported susceptible by the diagnostic laboratory). These results indicate that applying E-test directly on BAL samples is a promising method for obtaining susceptibility data after 24 h in critical patients with VAP.
authors.affiliation: CHU de Bordeaux, Service de Réanimation Médicale, F-33000 Bordeaux, France; University de Bordeaux, Bordeaux, France. alexandre.boyer@chu-bordeaux.fr
authors.forename: Alexandre
authors.initials: A
authors.lastname: Boyer
authors.forename: José
authors.initials: J
authors.lastname: Medrano
authors.forename: Fatima
authors.initials: F
authors.lastname: Mzali
authors.forename: Claude-Charles
authors.initials: CC
authors.lastname: Balick-Weber
authors.forename: Emilie
authors.initials: E
authors.lastname: Bessède
authors.forename: Walter
authors.initials: W
authors.lastname: Picard
authors.forename: Benjamin
authors.initials: B
authors.lastname: Clouzeau
authors.forename: Cécile M
authors.initials: CM
authors.lastname: Bébéar
authors.forename: Frédéric
authors.initials: F
authors.lastname: Vargas
authors.forename: Gilles
authors.initials: G
authors.lastname: Hilbert
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Rogues
authors.forename: Didier
authors.initials: D
authors.lastname: Gruson
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D015331:Cohort Studies; D060085:Coinfection / Q000175:diagnosis / Q000382:microbiology; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods*; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000382:microbiology; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000382:microbiology*; D015203:Reproducibility of Results
chemical_list: D000900:Anti-Bacterial Agents