Comparison of non-protected lower respiratory tract secretions and protected specimen brush samples in the diagnosis of pneumonia

Richard, Christian; Pezzano, M; Bouhaja, B; Rottman, E; Rimailho, A; Riou, Bruno; Auzepy, P

doi:10.1007/bf00254118

Cited by 19 publications

(5 citation statements)

References 19 publications

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“…A negative EA culture would probably rule out pulmonary infection. Similar considerations were stated by Richard and colleagues (25). Finally, a recent publication by Middleton and associates (26), comparing EA, ACCU-CATH, PSB, and BAL for assessing VA pneumonia, showed a reasonable diagnostic value of Gram's stains and semi-quantitative cultures of EA.…”

Section: Discussionsupporting

confidence: 66%

Quantitative Cultures of Endotracheal Aspirates for the Diagnosis of Ventilator-associated Pneumonia

El-Ebiary¹,

Torres²,

González³

et al. 1993

Am Rev Respir Dis

182

101

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Bronchoalveolar lavage (BAL) and protected specimen brushing (PSB) are the most commonly used methods for diagnosing ventilator-associated (VA) pneumonia although they require bronchoscopy. Endotracheal aspiration (EA) is a simple and less costly technique than PSB or BAL. The purpose of our study was to investigate the diagnostic value of EA quantitative cultures and to compare the results obtained using EA with those obtained using PSB and BAL in mechanically ventilated patients with or without pneumonia. We prospectively studied 102 intubated patients divided into three diagnostic categories: Group I (definite pneumonia, n = 26), Group II (uncertain status, n = 48), and Group III (control group, n = 28). All patients received prior antibiotic treatment. EA, PSB, and BAL were obtained sequentially in all patients. When comparing Group I with Group III and using 10(5) cfu/ml as a threshold, we found that EA quantitative cultures represented a relatively sensitive (70%) and relatively specific (72%) method to diagnose VA pneumonia. The specificity of BAL and PSB (87% and 93%, respectively) was better than that of EA. The negative predictive value of EA cultures was higher (72%) when compared with that obtained using PSB (34%) (p < 0.05). EA quantitative cultures correlated with PSB and BAL quantitative cultures in patients with definite pneumonia. Although EA quantitative cultures are less specific than PSB and BAL for diagnosing VA pneumonia, our results suggest that the former approach may be used to treat these patients when bronchoscopic procedures are not available.

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Section: Discussionsupporting

confidence: 66%

Quantitative Cultures of Endotracheal Aspirates for the Diagnosis of Ventilator-associated Pneumonia

El-Ebiary¹,

Torres²,

González³

et al. 1993

Am Rev Respir Dis

182

101

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“…Two reports from our group [10,11] comparing qualitative cultures of endotracheal aspirates to quantitative cultures of protected specimen brush (PSB) and bronchoalveolar lavage (BAL) samples concluded that endotracheal aspiration was nonspecific (specificity 20-30%) in diagnosing ventilator-associated pneumonia. Some studies are consistent with these findings (12,15], although others have reported different results. For instance, KAsiAN et al [16] showed that endotracheal aspiration samples taken immediately after intubation were useful in 11 out of 14 children with a pulmonary infection.…”

Section: Non-invasive Techniquessupporting

confidence: 70%

Accuracy of diagnostic tools for the management of nosocomial respiratory infections in mechanically ventilated patients

Torres¹

1991

Eur Respir J

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This article reviews the medical literature concerning available diagnostic tools for managing nosocomial respiratory infections in mechanically ventilated patients. The first part deals with the reliability of the clinical criteria used in diagnosing nosocomial pneumonia in such patients and the accuracy of simple markers of pneumonia such as elastin fibres stain and antibody-coated bacteria. The second part reviews the presently available non-invasive and invasive methods for diagnosing pulmonary infections acquired during mechanical ventilation. With regard to invasive methods, protected specimen brush and bronchoalveolar lavage are extensively discussed in view of the different results in the literature. At the present time, these two methods seem to be the most accurate techniques available. The fact that bronchoalveolar lavage may combine the cytological examination and the quantitative culture of the sample obtained is noted. The role of percutaneous lung needle aspiration is also mentioned. Finally, histological diagnosis of pneumonia and pulmonary postmortem biopsy cultures are reviewed as "gold-standard" reference methods for investigation in this field. Future directions for further clinical research are addressed.

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“…Concomitant antimicrobial agents were employed by 42 (43%) ciprofloxacin-treated patients and 50 (47%) imipenem-treated patients in the efficacy-evaluable population. The concomitant antibacterial agents permitted by the protocol included vancomycin (27 patients) and metronidazole (11 patients) in the ciprofloxacin treatment group.…”

Section: Resultsmentioning

confidence: 99%

“…Recent data suggest that the clinical criteria used to diagnose pneumonia lack specificity (2,13,42,45,46). Although strict diagnostic criteria were employed, newer invasive diagnostic methods, such as use of a protected specimen brush or bronchoalveolar lavage, were not routinely employed in this study.…”

Section: Downloaded Frommentioning

confidence: 99%

“…The clinical diagnosis of pneumonia based upon conventional criteria only (i.e., fever, leukocytosis, new infiltrates on chest roentgenogram, and purulent sputum) may be inaccurate (2,7,12,14,44,53). Moreover, results obtained by culturing sputum aspirated from the airways of endotracheally intubated, mechanically ventilated patients may lack specificity compared with results obtained by more invasive means of sampling bronchial secretions (2,12,42,45,46). In addition, pneumonia in mechanically ventilated patients is often polymicrobial (18).…”

Section: 009)mentioning

confidence: 99%

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Treatment of severe pneumonia in hospitalized patients: results of a multicenter, randomized, double-blind trial comparing intravenous ciprofloxacin with imipenem-cilastatin. The Severe Pneumonia Study Group

Fink

Snydman

Niederman

et al. 1994

Antimicrob Agents Chemother

445

240

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Intravenously administered ciprofloxacin was compared with imipenem for the treatment of severe pneumonia. In this prospective, randomized, double-blind, multicenter trial, which included an intent-to-treat analysis, a total of 405 patients with severe pneumonia were enrolled. The mean APACHE II score was 17.6, 79%o of the patients required mechanical ventilation, and 78% had nosocomial pneumonia. A subgroup of 205 patients (98 ciprofloxacin-treated patients and 107 imipenem-treated patients) were evaluable for the major efficacy endpoints. Patients were randomized to receive intravenous treatment with either ciprofloxacin (400 mg every 8 h) or imipenem (1,000 mg every 8 h), and doses were adjusted for renal function. The primary and secondary efficacy endpoints were bacteriological and clinical responses at 3 to 7 days after completion of therapy. Ciprofloxacin-treated patients had a higher bacteriological eradication rate than did imipenem-treated patients (69 versus 59%o; 95% confidence interval of -0.6%, 26.2%; P = 0.069) and also a significantly higher clinical response rate (69 versus 56%; 95% confidence interval of 3.5%, 28.5%; P = 0.021). The greatest difference between ciprofloxacin and imipenem was in eradication of members of the family Enterobateriaceae (93 versus 65%; P = 0.009). Stepwise logistic regression analysis demonstrated the following factors to be associated with bacteriological eradication: absence of Pseudomonas aeruginosa (P < 0.01), higher weight (P < 0.01), a low APACHE IH score (P = 0.03), and treatment with ciprofloxacin (P = 0.04). When P. aeruginosa was recovered from initial respiratory tract cultures, failure to achieve bacteriological eradication and development of resistance during therapy were common in both treatment groups (67 and 33% for ciprofloxacin and 59 and 53% for imipenem, respectively). Seizures were observed more frequently with imipenem than with ciprofloxacin (6 versus 1%; P = 0.028). These results demonstrate that in patients with severe pneumonia, monotherapy with ciprofloxacin is at least equivalent to monotherapy with imipenem in terms of bacteriological eradication and clinical response. For both treatment groups, the presence of P. aeruginosa had a negative impact on treatment success. Seizures were more common with imipenem than with ciprofloxacin. Monotherapy for severe pneumonia is a safe and elfective initial strategy but may need to be modified if P. aeruginosa is suspected or recovered from patients.Despite improvements in antimicrobial chemotherapy and supportive care, bacterial pneumonia, whether nosocomial or community acquired, remains an infection with substantial mortality. Nosocomial pneumonia accounts for about 15% of

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Comparison of non-protected lower respiratory tract secretions and protected specimen brush samples in the diagnosis of pneumonia

Cited by 19 publications

References 19 publications

Quantitative Cultures of Endotracheal Aspirates for the Diagnosis of Ventilator-associated Pneumonia

Quantitative Cultures of Endotracheal Aspirates for the Diagnosis of Ventilator-associated Pneumonia

Accuracy of diagnostic tools for the management of nosocomial respiratory infections in mechanically ventilated patients

Treatment of severe pneumonia in hospitalized patients: results of a multicenter, randomized, double-blind trial comparing intravenous ciprofloxacin with imipenem-cilastatin. The Severe Pneumonia Study Group

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