Diagnosis of ventilator-associated pneumonia in children in resource-limited setting: A comparative study of bronchoscopic and nonbronchoscopic methods*

Abstract

Blind bronchoalveolar lavage was the most reliable method followed closely by blind bronchial sampling for the diagnosis of ventilator-associated pneumonia. Considering the difference of the cost in the two procedures, blind bronchial sampling may be the preferred method in the pediatric intensive care unit of a developing country.

Bronchoscopic and Nonbronchoscopic Methods of Airway Culturing in Tracheostomized Children

“…For example, P. aeruginosa was the most common pathogenic organism isolated in our cohort of patients. This finding is in agreement with previously published data 8,16 and highlights the importance of culturing lower respiratory tract secretions to make the appropriate antibiotic choice for treatment.…”

“…Sachdev et al 16 reported that endotracheal aspirate cultures have high false-positive rates in microbiological diagnostics of VAP in children secondary to colonization of proximal airways. The suction channels of flexible bronchoscopes are frequently contaminated with upper airway flora during instrument insertion.…”

“…For example, cystic fibrosis practitioners tend to use higher thresholds for BAL quantitative cultures (usually 10 5 CFU/ mL), 4,18 whereas the threshold of 10 4 CFU/mL is considered to be acceptable for the diagnosis of lower respiratory tract infections in non-cystic fibrosis patients. 5 Different diagnostic thresholds for positive quantitative cultures have been established for BP-BAL, B-BAL, and TA by previous investigators 7,16,19 and were used in our study. The lowest threshold of 10 2 for BP-BAL as applied in our study was also used by Timsit et al, 20 and it provided a higher sensitivity in determining significant positivity of the cultures obtained, although specificity was somewhat decreased.…”

Estrategias para reducir infecciones, uso de antimicrobianos y sus efectos en una unidad de neonatología

“…Después de revisar las publicaciones descritas en relación a la toma de muestra de secreción traqueal y diagnóstico de NAVM [30][31][32] , se estableció que la muestra debía tomarse con técnica estéril aplicando previamente 1 ml de NaCl 1‰ estéril y luego realizar una sola aspiración. Esta muestra se cultiva y procesa en forma cuantitativa.…”

Ventilator-associated pneumonia or bacterial colonization of the airway, what do probiotics decrease?

“…Though non-bronchoscopic techniques provide etiological clues, quantitative cultures alone ([10 4 CFU/ml) can differentiate between colonization and true infection [3]. Without quantitative cultures, the significant reduction in prevalence of airway colonization with Klebsiella and Pseudomonas in the probiotic group may not be a true reflection of a reduction in VAP.…”