Evaluation of Clinical Judgment in the Identification and Treatment of Nosocomial Pneumonia in Ventilated Patients

Fagon, Jean-Yves; Chastre, Jean; Hance, Allan J.; Domart, Y.; Trouillet, Jean‐Louis; Gibert, Claude

doi:10.1378/chest.103.2.547

Cited by 316 publications

(119 citation statements)

References 20 publications

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“…Clinical diagnosis is commonly inaccurate in recognizing ventilator-associated bacterial pneumonia [3,27,28]. In the present work, all of the 14 patients with histologically proven ventilator-associated bacterial pneumonia showed the complete clinical picture of ventilatorassociated bacterial pneumonia before death compared with five of the 13 patients without histological evidence.…”

Section: Discussionmentioning

confidence: 51%

Diagnostic accuracy of protected catheter sampling in ventilator-associated bacterial pneumonia

Papazian¹,

Thomas²,

Carret³

et al. 2000

European Respiratory Journal

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Section: Discussionmentioning

confidence: 51%

Diagnostic accuracy of protected catheter sampling in ventilator-associated bacterial pneumonia

Papazian¹,

Thomas²,

Carret³

et al. 2000

European Respiratory Journal

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“…However, it could be argued that knowing what the current flora is in an individual intensive care unit (ICU) is important for choosing the correct empiric antibiotics [19]. The proponents of diagnostic sampling have pointed out that clinical criteria alone misidentify up to half of the patients with possible VAP [3,7,20]. This includes the overuse of antibiotics for pathogens colonizing the upper airways.…”

Section: Discussionmentioning

confidence: 99%

Ventilator associated pneumonia: quality of nonbronchoscopic bronchoalveolar lavage sample affects diagnostic yield

Baughman¹,

Spencer²,

Kleykamp³

et al. 2000

Eur Respir J

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The importance of predefined criteria for acceptable samples of respiratory therapists′ obtained lower respiratory samples were studied, using a nonbronchoscopic bronchoalveolar lavage (BAL) protocol for ventilated patients in the intensive care unit. Therapists were instructed and asked to follow guidelines for obtaining samples. Over one year, 219 samples were obtained by respiratory therapists. Of these, 115 were considered to be adequate samples using the following criteria: 60 mL of instilled volume, at least 5 mL of fluid aspirated, specimens sent for semiquantitative culture, a differential cell count of <5% bronchial epithelial cells. Overall, 52 samples grew one or more pathogen at >10,000 colony forming units (cfu)·mL‐1 of BAL. The most common pathogen was Staphylococcus aureus (S. aureus) (11 samples), although Gram‐negative bacilli were the single pathogen in 21 specimens. Of the 115 acceptable samples, 40 (35%) grew ≥1 pathogen at >10,000 cfu·mL‐1. For the 80 not acceptable samples which were sent for appropriate culture, 12 (15%) grew >10,000 cfu·mL‐1 BAL. This difference was significant (Chi‐squared=9.44, p<0.01). Nonbronchoscopic bronchoalveolar lavage can be safely performed by respiratory therapists′. The authors recommend that a protocol be used to evaluate the quality of a bronchoalveolar lavage sample in the same manner sputum samples are screened prior to interpretation.

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“…Receipt of selected antimicrobials may increase the risk of upper airway colonization of ventilated patients with resistant Gram-negative organisms [27][28][29][30]. In this investigation, receipt of a cephalosporin and the combination of a cephalosporin and an aminoglycoside were associated with B. cepacia acquisition by univariate analysis; these were antimicrobials to which the B. cepacia isolates were resistant.…”

Section: Administration Of Nebulized Medicationsmentioning

confidence: 93%

Burkholderia cepacia respiratory tract acquisition: epidemiology and molecular characterization of a large nosocomial outbreak

Pegues

Ford

et al. 1996

Epidemiol. Infect.

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SUMMARYIn 1994 we investigated a large outbreak of Burkholderia (formerly Pseudomonas) cepacia respiratory tract acquisition. A case patient was defined as any patient with at least one sputum culture from which B. cepacia was isolated from 1 January to 31 December 1994. Seventy cases were identified. Most (40 [61 %]) occurred between 1 February and 31 March 1994; of these, 35 (86%) were mechanically ventilated patients, 30 of whom were in an intensive-care unit (ICU) when B. cepacia was first isolated. Compared with control patients who were mechanically ventilated in an ICU, these 30 case-patients were significantly more likely to have been ventilated for 2 or more days (30/30 v. 15/30; P < 0-001) or to have been intubated more than once (12/30 v. 2/30; OR = 9-3, 95 % CI 1P6-68-8; P = 0-002) before the first isolation of B. cepacia. By multivariate analysis, the 35 mechanically ventilated casepatients were significantly more likely to have received a nebulized medication (OR = 11 9, 95 % CI = 1-6-553 1; P < 0-001) and a cephalosporin antimicrobial (OR = 11 9, 95 % CI = 1-6-553 1) in the 10 days before the first isolation of B. cepacia, compared with B. cepacianegative control-patients matched by date and duration of most recent mechanical ventilation. Although B. cepacia was not cultured from medications or the hospital environment, all outbreak strains tested had an identical DNA restriction endonuclease digestion pattern by pulsed-field gel electrophoresis. Review of respiratory therapy procedures revealed opportunities for contamination of nebulizer reservoirs. This investigation suggests that careful adherence to standard procedures for administration of nebulized medications is essential to prevent nosocomial respiratory infections.

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Evaluation of Clinical Judgment in the Identification and Treatment of Nosocomial Pneumonia in Ventilated Patients

Cited by 316 publications

References 20 publications

Diagnostic accuracy of protected catheter sampling in ventilator-associated bacterial pneumonia

Diagnostic accuracy of protected catheter sampling in ventilator-associated bacterial pneumonia

Ventilator associated pneumonia: quality of nonbronchoscopic bronchoalveolar lavage sample affects diagnostic yield

Burkholderia cepacia respiratory tract acquisition: epidemiology and molecular characterization of a large nosocomial outbreak

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