Diagnostic value of direct examination of the protected specimen brush in ventilator-associated pneumonia

Ch, Marquette; Wallet, Frédéric; Nevière, Rémi; Mc, Copin; Saulnier, F.; Drault, J. N.; Mehdaoui, H; Mathieu, Daniel; Ramon, P

doi:10.1183/09031936.94.07010105

Cited by 33 publications

(9 citation statements)

References 26 publications

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“…The presence of microorganisms on Gram stain examination of protected specimen brush samples has been shown to be highly sensitive and specific of the diagnosis of HAP (16). Marquette and coworkers reported high sensitivity (85%) and specificity (94%) for the Gram stain examination of protected specimen brush (17). However, Pham and coworkers found a poor sensitivity (20%) of Gram stain of the protected specimen brush to detect culture-positive samples, although the specificity was high (95%) (1).…”

Section: Discussionmentioning

confidence: 96%

Value of Gram Stain Examination of Lower Respiratory Tract Secretions for Early Diagnosis of Nosocomial Pneumonia

Blot

Raynard

Chachaty

et al. 2000

Am J Respir Crit Care Med

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Except for bronchoalveolar lavage, the value of the Gram stain examination of respiratory tract samples for the diagnosis of hospital-acquired pneumonia (HAP) and their potential impact on empiric antibiotic treatment have rarely been assessed. During a 14-mo period, both plugged telescoping catheter (PTC) and endotracheal aspirate (EA) were performed when an HAP was suspected in mechanically ventilated patients. The results of Gram stain examinations and cultures and previous and subsequent antibiotic treatment were prospectively recorded. Two criteria for pneumonia were considered: (1) clinically diagnosed pneumonia, according to attending physicians, based on clinical and radiological evolution and the PTC culture results, and (2) microbiologically proven pneumonia (solely based on the result of quantitative PTC culture). Of 91 episodes of suspected HAP in 51 patients, 27 (30%) episodes were clinically diagnosed as pneumonia. When considering clinically diagnosed pneumonia, the sensitivity and specificity of Gram stain examination were similar (respectively, 89% and 62% for EA and 67% and 95% for PTC). When considering microbiologically proven pneumonia, the sensitivity and specificity of Gram stain examination were, respectively, 91% and 64% for EA and 70% and 96% for PTC. The negative predictive value of Gram stain examination of EA and the positive predictive value of Gram stain examination of PTC were high. Our results suggest that the combination of Gram stain examination of paired PTC and EA may contribute to the early diagnosis of HAP in about two-thirds of mechanically ventilated patients, and guide the empiric therapy when needed. In the remaining one-third of patients, the Gram stain examination is not helpful in predicting HAP.

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Section: Discussionmentioning

confidence: 96%

Value of Gram Stain Examination of Lower Respiratory Tract Secretions for Early Diagnosis of Nosocomial Pneumonia

Blot

Raynard

Chachaty

et al. 2000

Am J Respir Crit Care Med

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“…41,42,46 A disadvantage of the brush is the limited amount of sample obtained. Rarely is the sample examined for inflammatory cells such as neutrophils, 47 which would help to distinguish between a bland colonization and a frank infection. Also, the sample cannot be studied for proinflammatory cytokines such as interleukin 8, which may indicate an active inflammation.…”

Section: Protected Specimen Brushmentioning

confidence: 99%

Infections in Acute Exacerbation of Chronic Bronchitis: What Are They and How Do We Know?

Baughman

Pina²

2000

Seminars in Respiratory and Critical Care Medicine

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Acute exacerbations of chronic bronchitis can be due to many factors. The most commonly recognized factor is infection, with bacterial infection being identified in about fifty percent of patients with chronic bronchitis. The causative agent can be detected by several different methods. The most common is sputum examination; however, more invasive techniques have been studied. These include transtracheal aspirates and bronchoscopic samples. The most widely studied bronchoscopic sample has been the protected brush specimen (PBS). Despite the wide array of sampling techniques, the pathogens which have been identified have been relatively consistent. The three most common pathogens have been H. influenzae, S. Pneumoniae, and B. catarrhalis. Other pathogens, including gram negative enteric organisms, are seen in patients with more advanced disease. The information obtained by the diagnostic studies has allowed clinicians to develop treatment strategies for AECB. These diagnostic studies will be needed to help upgrade treatment guidelines as new bacteria and bacterial resistance patterns change.

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“…MONTRAVERS et al [39] reported that antibiotics can sterilize the respiratory samples collected by PSB after only 3 days of effective treatment. A recent histological study has con®rmed that the sensitivity of any sampling technique and the bacterial burden of the lung are both dramatically decreased by the initiation of the antibiotic treatment [27]. This effect is less evident when the antibiotics are ineffective against the causative micro-organisms [40].…”

Section: Bronchoscopic Techniquesmentioning

confidence: 99%

“…2) Squamous epithelial cells (SECs) and bronchial ciliated cells (BCCs): the presence of >1% SECs in BAL is indicative of oropharyngeal contamination [68,71]. There is poor evidence about the signi®cance of SECs in PSB, but it appears that their absence or presence in very small amounts (¡1 per ®eld) is a predictor of a good quality PSB sample [27]. The presence of BCCs as a marker of contamination in mechanically ventilated patients has not been thoroughly investigated.…”

Section: Microscopic Analysismentioning

confidence: 99%

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Microbial investigation in ventilator-associated pneumonia

Ioanăş¹,

Ferrer²,

Angrill³

et al. 2001

Eur Respir J

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Ventilator-associated pneumonia (VAP) is a serious infectious condition in intensive care unit (ICU) patients, currently related to a high mortality rate. Therefore, this complication of mechanical ventilation requires a prompt diagnosis and adequate antibiotic treatment. The detection of the causative organism is imperative for guiding an appropriate therapy as there is strong evidence of the adverse effect of inadequate empirical treatment on outcome. The major difficulty of the microbial investigation is to obtain the sample from the lower respiratory tract, mainly because of the potential contamination with upper airways flora, which may result in a misinterpretation of the cultures.Microbial investigation in VAP is based on the culture of samples obtained from lower respiratory tract by noninvasive or invasive methods. The most common techniques of sampling are the endotracheal aspirate (ETA), which is considered a noninvasive method, the protected specimen brush (PSB) and the bronchoalveolar lavage (BAL), both being invasive methods of investigation. The latter were designed as an attempt to avoid the colonizing flora of the upper airways. The best of these diagnostic approaches is still controversial. In terms of outcome, there is strong evidence that the impact of both invasive and noninvasive methods seems to be similar. In terms of cost, however, the endotracheal aspirate is less expensive compared to BAL or PSB. On the other hand, invasive methods could be particularly beneficial in patients who are not responding to the initial empirical antibiotic treatment.The rationale for the quantitative culture of the respiratory samples is to differentiate between infection and colonization of lower airways, because the bacterial colonization is a frequent event in mechanically ventilated patients. The thresholds currently employed for the diagnosis of the pneumonia are the following: ETA samples, ≥105–106colony forming units (cfu)·mL−1; PSB samples, ≥103cfu·mL−1; and BAL samples, ≥104 cfu·mL−1.Intending to provide a practical approach to the issue, the present manuscript reviews the available noninvasive (blood culture, endotracheal aspirate) and invasive (protected specimen brush, bronchoalveolar lavage, blinded methods and lung biopsy) techniques used for the diagnosis of ventilator-associated pneumonia.

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Diagnostic value of direct examination of the protected specimen brush in ventilator-associated pneumonia

Cited by 33 publications

References 26 publications

Value of Gram Stain Examination of Lower Respiratory Tract Secretions for Early Diagnosis of Nosocomial Pneumonia

Value of Gram Stain Examination of Lower Respiratory Tract Secretions for Early Diagnosis of Nosocomial Pneumonia

Infections in Acute Exacerbation of Chronic Bronchitis: What Are They and How Do We Know?

Microbial investigation in ventilator-associated pneumonia

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