Diagnosis of ventilator-associated pneumonia: agreement between quantitative cultures of endotracheal aspiration and plugged telescoping catheter

Elatrous, Souheil; Boukef, Riadh; Ouanes-Besbes, Lamia; Marghli, Soudani; Nooman, Sami; Abroug, Fékri

doi:10.1007/s00134-004-2270-0

Cited by 25 publications

(14 citation statements)

References 28 publications

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“…However, for the purpose of benchmarking, a common, generally accepted and validated definition is needed, preferably one that does not require invasive diagnostic procedures. With the recent validation of quantitative tracheal cultures for the diagnosis of pneumonia [22,23], relevant cultures may be more readily available.…”

Section: Discussionmentioning

confidence: 99%

Nosocomial pneumonia in the ICU: A prospective cohort study

Hyllienmark¹,

Gårdlund²,

Persson³

et al. 2007

Scandinavian Journal of Infectious Diseases

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Ventilator-associated pneumonia (VAP) is the most common intensive care unit (ICU)-acquired infection among patients requiring mechanical ventilation. A prospective surveillance programme of all patients has been implemented at the ICU, Karolinska University Hospital, Sweden since 2001. Within this programme, incidence and risk factors for ICU-acquired pneumonia and associated death over a 2-y period have been studied. Of 329 patients enrolled in the study, 221 required mechanical ventilation. 33 of 221 patients (15%) developed VAP, corresponding to a rate of 29 VAP/1000 ventilator d. Risk factors for VAP were aspiration (hazard ratio 3.79; 95% CI 1.48-9.68), recent surgery (HR 3.58; 95% CI 1.15-11.10) and trauma (HR 3.00; 95% CI 1.03-8.71). 11 patients of 33 (33%) with VAP died within 28 d compared to 46 of 288 (16%) without ICU-acquired pneumonia (odds ratio 2.73; 95% CI 0.97-7.63). We conclude that: 1) incidence of VAP was 15% and the most important risk factor was aspiration; 2) APACHE II score > or = 20 is a stronger predictor for poor outcome than VAP; 3) a minority of patients with APACHE II score > or = 20 develop VAP; and 4) continuous surveillance programmes are feasible and provide valuable data for improvement of quality of care.

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Section: Discussionmentioning

confidence: 99%

Nosocomial pneumonia in the ICU: A prospective cohort study

Hyllienmark¹,

Gårdlund²,

Persson³

et al. 2007

Scandinavian Journal of Infectious Diseases

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“…We concluded in a previous commentary [2] that unless one is a researcher with a particular attachment to one invasive procedure, it is rational to use the least invasive procedure. Two limited studies of cultures of endotracheal aspirates versus cultures of samples obtained by invasive methods found no impact on mortality or clinical response [19,49]. Light [50], stating that bronchoscopic BAL and PSB specimens are merely variable dilutions of the endotracheal aspirate, concluded that specimens obtained from locations only 5-15 cm apart along a patient's airway are unlikely to have substantially different bacteria.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Cultures for Diagnosing Ventilator-Associated Pneumonia: A Critique

Fujitani

2006

Clinical Infectious Diseases

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The diagnosis of ventilator-associated pneumonia has been clouded by uncertainty, because a reference standard has never been established. The use of invasive procedures to obtain respiratory tract samples for culture, with quantitation of the bacteria isolated, has been the approach most commonly advocated. Quantitation of bacteria from lower respiratory tract specimens can be used to distinguish colonization from infection. We review the invasive procedures (bronchoalveolar lavage, protected specimen brushing, nonbronchoscopic bronchoalveolar lavage, and blinded bronchial sampling), the methods of quantitation used, the types of catheters used, the sample collection methods, and the criteria used as cutoffs for the quantitative cultures. Quantitation of lower respiratory tract samples is inherently unstable from a mathematical perspective, given the variability in the volume of fluid instilled and reaspirated and the magnitude and complexity of the area being sampled. We also briefly review the use of quantitation for bacterial infections other than pneumonia, including urinary tract infection and catheter-related bacteremia. The variability in both the methods and reference criteria in the studies reviewed show that the quantitation approach is neither standardized nor evidence based.

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“…Ventilator-associated pneumonia is commonly observed (in 9-68%) and is a serious condition. (16) Cunnion et al (17) reported that the major risk factor for nosocomial pneumonia in surgical and medical/ respiratory ICUs is prolonged MV, resulting in a 12 times higher risk for ventilated patients than for nonventilated patients. This is in agreement with the findings of the present study.…”

Section: Discussionmentioning

confidence: 99%

Mortalidade e fatores associados em uma UTI de cirurgia torácica

Şentürk

Sen

et al. 2011

J. bras. pneumol.

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Objective: To assess mortality and identify mortality risk factors in patients admitted to a thoracic surgery ICU. Methods: We retrospectively evaluated 141 patients admitted to the thoracic surgery ICU of the Denizli State Hospital, located in the city of Denizli, Turkey, between January of 2006 and August of 2008. We collected data regarding gender, age, reason for admission, invasive interventions and operations, invasive mechanical ventilation, infections, and length of ICU stay. Results: Of the 141 patients, 103 (73.0%) were male, and 38 (23.0%) were female. The mean age was 52.1 years (range, 12-92 years), and the mortality rate was 16.3%. The most common reason for admission was trauma. Mortality was found to correlate with advanced age (p < 0.05), requiring invasive mechanical ventilation (OR = 42.375; p < 0.05), prolonged ICU stay (p < 0.05), and specific reasons for admission-trauma, gunshot wound, stab wound, and malignancy (p < 0.05 for all). Conclusions: Among patients in a thoracic surgery ICU, the rates of morbidity and mortality are high. Increased awareness of mortality risk factors can improve the effectiveness of treatment, which should reduce the rates of morbidity and mortality, thereby providing time savings and minimizing costs. Keywords:Intensive care units; Thoracic surgery/mortality; Hospital mortality; Risk factors. ResumoObjetivo: Determinar a mortalidade e identificar fatores de riscos associados em pacientes em uma UTI de cirurgia torácica. Métodos: Foram avaliados retrospectivamente 141 pacientes admitidos na UTI de cirurgia torácica do Hospital Estadual de Denizli, localizado na cidade de Denizli, Turquia, entre janeiro de 2006 e agosto de 2008. Foram coletados dados sobre gênero, idade, causa de admissão, intervenções invasivas e operações, status de ventilação mecânica invasiva, infecções e tempo de permanência na UTI. Resultados: Dos 141 pacientes, 103 (73,0%) eram do sexo masculino e 38 (23,0%) do sexo feminino. A média de idade foi de 52,1 anos (variação: 12-92 anos), e a taxa de mortalidade foi de 16,3%. A causa de admissão mais frequente foi trauma. A mortalidade correlacionou-se com idade avançada (p < 0,05), uso de ventilação mecânica invasiva (OR = 42,375; p < 0,05), longa permanência na UTI (p < 0,05) e causas de admissão específicas -trauma, injúria por arma de fogo, injúria por arma branca e malignidade (p < 0,05 para todos). Conclusões: Os pacientes em uma UTI de cirurgia torácica têm alta morbidade e mortalidade. Um conhecimento maior dos fatores de risco de mortalidade pode melhorar a eficiência do tratamento, resultando em diminuição da morbidade e mortalidade, o que gerará economia de tempo e reduzirá os custos financeiros.

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Diagnosis of ventilator-associated pneumonia: agreement between quantitative cultures of endotracheal aspiration and plugged telescoping catheter

Abstract: Quantitative cultures of ETA and PTC tallied for both micro-organisms and counts. The simpler ETA appears adequate for determining the presence of pathogenic organisms in significant concentration in the lower respiratory tract.

Cited by 25 publications

References 28 publications

Nosocomial pneumonia in the ICU: A prospective cohort study

Nosocomial pneumonia in the ICU: A prospective cohort study

Quantitative Cultures for Diagnosing Ventilator-Associated Pneumonia: A Critique

Mortalidade e fatores associados em uma UTI de cirurgia torácica

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