title: Quantitative culture of endotracheal aspirate and BAL fluid samples in the management of patients with ventilator-associated pneumonia: a randomized clinical trial.
abstract: OBJECTIVE
  To compare 28-day mortality rates and clinical outcomes in ICU patients with ventilator-associated pneumonia according to the diagnostic strategy used.
  
  
  METHODS
  This was a prospective randomized clinical trial. Of the 73 patients included in the study, 36 and 37 were randomized to undergo BAL or endotracheal aspiration (EA), respectively. Antibiotic therapy was based on guidelines and was adjusted according to the results of quantitative cultures.
  
  
  RESULTS
  The 28-day mortality rate was similar in the BAL and EA groups (25.0% and 37.8%, respectively; p = 0.353). There were no differences between the groups regarding the duration of mechanical ventilation, antibiotic therapy, secondary complications, VAP recurrence, or length of ICU and hospital stay. Initial antibiotic therapy was deemed appropriate in 28 (77.8%) and 30 (83.3%) of the patients in the BAL and EA groups, respectively (p = 0.551). The 28-day mortality rate was not associated with the appropriateness of initial therapy in the BAL and EA groups (appropriate therapy: 35.7% vs. 43.3%; p = 0.553; and inappropriate therapy: 62.5% vs. 50.0%; p = 1.000). Previous use of antibiotics did not affect the culture yield in the EA or BAL group (p = 0.130 and p = 0.484, respectively).
  
  
  CONCLUSIONS
  In the context of this study, the management of VAP patients, based on the results of quantitative endotracheal aspirate cultures, led to similar clinical outcomes to those obtained with the results of quantitative BAL fluid cultures. (Brazilian Registry of Clinical Trials--ReBEC; identification number RBR-86DCDX [http://www.ensaiosclinicos.gov.br]).
authors.affiliation: Federal University of Minas Gerais, School of Medicine, Department of Pulmonology and Thoracic Surgery, Belo Horizonte, Brazil. Department of Pulmonology and Thoracic Surgery, Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil.
authors.forename: Ricardo de Amorim
authors.initials: Rde A
authors.lastname: Corrêa
authors.affiliation: University of Buenos Aires, Hospital de Clínicas, Buenos Aires, Argentina. Hospital de Clínicas, University of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Carlos Michel
authors.initials: CM
authors.lastname: Luna
authors.affiliation: Hospital Madre Teresa, Belo Horizonte, Brazil. Intensive Care Unit, Hospital Madre Teresa, Belo Horizonte, Brazil.
authors.forename: José Carlos Fernandez Versiani dos
authors.initials: JC
authors.lastname: Anjos
authors.affiliation: Hospital Madre Teresa, Belo Horizonte, Brazil. Laboratory of Microbiology, Hospital Madre Teresa, Belo Horizonte, Brazil.
authors.forename: Eurípedes Alvarenga
authors.initials: EA
authors.lastname: Barbosa
authors.affiliation: Hospital Madre Teresa, Department of Radiology, Belo Horizonte, Brazil. Department of Radiology, Hospital Madre Teresa, Belo Horizonte, Brazil.
authors.forename: Cláudia Juliana de
authors.initials: CJ
authors.lastname: Rezende
authors.affiliation: Hospital Madre Teresa, Department of Pulmonology and Thoracic Surgery, Belo Horizonte, Brazil. Department of Pulmonology and Thoracic Surgery, Hospital Madre Teresa, Belo Horizonte, Brazil.
authors.forename: Adriano Pereira
authors.initials: AP
authors.lastname: Rezende
authors.affiliation: Federal University of Minas Gerais, School of Medicine, Postgraduate Center, Belo Horizonte, Brazil. Postgraduate Center, Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil.
authors.forename: Fernando Henrique
authors.initials: FH
authors.lastname: Pereira
authors.affiliation: Federal University of Minas Gerais, School of Medicine, Belo Horizonte, Brazil. Postgraduate Program in Health Sciences, Infectology and Tropical Medicine, Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil.
authors.forename: Manoel Otávio da Costa
authors.initials: MO
authors.lastname: Rocha
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D014132:Trachea / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bronchoalveolar lavage fluid/diagnosis; Pneumonia, ventilator-associated; Respiratory aspiration