Use of the Protected Specimen Brush in Patients with Endotracheal or Tracheostomy Tubes

Baughman, Robert P.; Thorpe, Joseph E.; Staneck, Joseph L.; Rashkin, Mitchell C.; Frame, Peter T.

doi:10.1378/chest.91.2.233

Cited by 160 publications

(61 citation statements)

References 5 publications

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“…The specificity obtained in our PSB-BF study was similar to that reported by many authors [10,[28][29][30]35].…”

Section: Discussionsupporting

confidence: 92%

“…However, the small number of cases with no RLL involvement does not permit us to draw definitive conclusions in this respect. Furthermore, previous studies have reported contradictory findings [6,12,28].…”

Section: Discussionmentioning

confidence: 95%

“…(lung biopsy and blood culture) have some limitations in their specificity [23]. As it is difficult to establish in practice a diagnosis of true VAP, most of the published studies have been made in patients with suspected VAP based on clinical criteria [9][10][11][12][13][14][24][25][26][27][28][29][30], as we did in our study. Some microorganisms, especially Haemophilus influenzae, Streptococcus pneumoniae, L. pneumophila and anaerobic bacteria, are very sensitive to saline transport media, and their concentrations decrease from 97 to 45% after one hour of exposure [31].…”

Section: Discussionmentioning

confidence: 99%

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"Blind" protected specimen brushing <I>versus</I> bronchoscopic techniques in the aetiolological diagnosis of ventilator-associated pneumonia

Bello

Tajada²,

Chacón³

et al. 1996

European Respiratory Journal

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The aetiological diagnosis of nosocomial pneumonia in intensive care unit (ICU) patients requires a valid, cheap and safe method. This method should be suitable for all mechanically-ventilated patients and all ICUs. The aim of this study was to assess the diagnostic yields of three methods: "blind" bronchial brushing (Accu-Cath)(protective specimen brush-nonbronchofibroscopic (PSB-non BF)); bronchofibroscopic protected specimen brushing (PSB-BF) and bronchoalveolar lavage (BAL).We prospectively studied the diagnostic values of the three methods as well as the agreement between microbiological results in 74 patients with 88 episodes of clinically suspected ventilator-associated pneumonia (VAP) and 22 control subjects. VAP episodes were also divided into those with (n=24) and without antibiotic pretreatment (n=64), and into those with (n=78) and without (n=10) right lower lobe infiltrates on chest radiography.No differences were found as regards the bacteriological yield of the three techniques. Furthermore, the rate of concordant results was high; 92% for PSB-BF and BAL; 84% for PSB-nonBF and BAL; 85% for PSB-nonBF and PSB-BF; and 85% for PSB-nonBF combined with both bronchoscopic techniques. The diagnostic yields in suspected VAP were 66, 59 and 56% for PSB-nonBF, PSB-BF and BAL, respectively.We conclude that "blind" bronchial brushing has similar accuracy to bronchoscopic techniques commonly used in the diagnosis of ventilator-associated pneumonia, constituting an interesting alternative in hospitals where fibreoptic bronchoscopy is not available.

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“…The specificity obtained in our PSB-BF study was similar to that reported by many authors [10,[28][29][30]35].…”

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

"Blind" protected specimen brushing <I>versus</I> bronchoscopic techniques in the aetiolological diagnosis of ventilator-associated pneumonia

Bello

Tajada²,

Chacón³

et al. 1996

European Respiratory Journal

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“…Hence, clinical interpretation of our findings may be difficult, as the distinction between colonizing and pathogenic organisms may not be clear. It is possible that quantitative cultures will allow better understanding of the roles of the various organisms during episodes of clinical exacerbation (2).…”

mentioning

confidence: 99%

Prevalence of Streptococcus pneumoniae in Respiratory Samples from Patients with Tracheostomy in a Long-Term-Care Facility

et al. 2012

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We aimed to study the prevalence of Streptococcus pneumoniae in respiratory samples from institutionalized patients with chronic tracheostomy. A total of 264 pairs of nasopharyngeal and endotracheal cultures were collected. There was no difference in the proportion of positive cultures between children (21%) and adults (18%). However, the proportion of positive endotracheal cultures was higher than that of nasopharyngeal cultures in adults (18% versus 3%, respectively; P < 0.001) but not in children (17% in both sites). Infection with Streptococcus pneumoniae can result in a range of illnesses, including bacteremia, meningitis, pneumonia, otitis media, and sinusitis, which together cause substantial morbidity and mortality worldwide (7). S. pneumoniae gains entry into the host by colonizing the nasopharyngeal (NP) mucosal epithelium. Although colonization at this site is usually asymptomatic, if the organism gains access to the normally sterile parts of the airway a rapid inflammatory response ensues, resulting in disease (6, 7). The colonization rate is much higher in young children than in adults (8) and is influenced by a variety of factors, including geographic location, season, overcrowding, and day care attendance (6). There is a paucity of data regarding the presence of S. pneumoniae in the lower respiratory tract (LRT) of individuals without acute infection. The data suggest that S. pneumoniae is absent in the airways of healthy individuals (4) or in children with recurrent wheezing (9), but it can be detected in a small proportion (7%) of patients with chronic obstructive pulmonary disease (COPD) (4). An epidemiologically distinct subpopulation among patients with chronic respiratory disorders comprises those with chronic tracheostomy tubes. In these patients, bacterial LRT colonization almost always follows tracheal intubation (3). Two studies reported a prevalence of S. pneumoniae in LRT cultures in chronic tracheostomy patients of 8% (4) and 42% (3). However, these studies were conducted on a small number of patients and did not include a concurrent assessment of the nasopharyngeal carriage rate. The aims of the present study were to study the prevalence of S. pneumoniae in respiratory samples of patients with chronic tracheostomy, to compare the carriage rates found in NP versus endotracheal (ET) cultures, and to assess the effects of demographic and microbiologic variables on the site of isolation.The Reuth Medical Center in Tel Aviv is a 300-bed, long-termcare facility (250 adults, 50 children) with patients divided into the following wards: chronically ventilated (adult and pediatric), rehabilitation, and skilled nursing care. The study was conducted in the context of an intervention initiated by the National Center for Infection Control to investigate the prevalence of fluoroquinolone-resistant S. pneumoniae in clinical cultures at the facility (10). A point prevalence surveillance study of S. pneumoniae colonization was conducted first in January 2009 followed by two follow-up surveys in Decemb...

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“…Protected specimen brush (PSB) was introduced by WIMBERLEY et al [5], and has improved the accuracy of the bacteriological diagnosis of pneumonia in ventilated [6][7][8][9][10][11] and nonventilated patients [12].…”

mentioning

confidence: 99%

Protected bronchoalveolar lavage in the diagnosis of ventilator-associated pneumonia

Barreiro¹,

Dorca²,

Manresa³

et al. 1996

European Respiratory Journal

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Use of the Protected Specimen Brush in Patients with Endotracheal or Tracheostomy Tubes

Cited by 160 publications

References 5 publications

"Blind" protected specimen brushing <I>versus</I> bronchoscopic techniques in the aetiolological diagnosis of ventilator-associated pneumonia

"Blind" protected specimen brushing <I>versus</I> bronchoscopic techniques in the aetiolological diagnosis of ventilator-associated pneumonia

Prevalence of Streptococcus pneumoniae in Respiratory Samples from Patients with Tracheostomy in a Long-Term-Care Facility

Protected bronchoalveolar lavage in the diagnosis of ventilator-associated pneumonia

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