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Vol. 39. Issue 9.
Pages 394-399 (September 2003)
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Vol. 39. Issue 9.
Pages 394-399 (September 2003)
Diagnostic Value of Quantitative Cultures of Endotracheal Aspirate in Ventilator-Associated Pneumonia: A Multicenter Study
Valor diagnóstico del cultivo cuantitativo del aspirado endotraqueal en la neumonía adquirida durante la ventilación mecánica. Estudio multicéntrico
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M. Valencia Arangoa, A. Torres Martíb, J. Insausti Ordeñanac, F. Álvarez Lermad, N. Carrasco Joaquinete, M. Herranz Casadof, JP. Tirapu Leónc
a Unidad de Cuidados Intensivos, Universidad Pontificia Bolivariana, Colombia. Hospital Clínic, Barcelona, Spain.
b Hospital Clínic, Barcelona, Spain.
c Hospital de Navarra, Pamplona-Iruña, Navarra, Spain.
d Hospital del Mar, Barcelona, Spain.
e Hospital de la Princesa, Madrid, Spain.
f Hospital Río Hortega, Valladolid, Spain.
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Tables (7)
TABLE 1. Demographic and Clinical Characteristics of the Patients*
TABLE 2. Isolation of Pathogens in Tracheal Aspirate and Plugged Telescoping Catheter Specimens in Patients With Pneumonia*
TABLE 3. Qualitative Microbiological Evaluation*
TABLE 4. Diagnostic Yield of Tests*
Fig. 1. ROC curve of tracheal aspirate specimens. Area under the curve: 0.716 (95% confidence interval, 0.625-0.746).
Fig. 2. ROC curve of plugged telescoping catheter specimens. Area under the curve: 0.790 (95% confidence interval, 0.705-0.860).
TABLE 5. Agreement Between Tracheal Aspirate and Plugged Telescoping Catheter Specimens in Patients With Pneumonia*
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Objective: To study the validity of quantitative cultures of tracheal aspirate (TA) in comparison with the plugged telescoping catheter (PTC) for the diagnosis of mechanical ventilator-associated pneumonia. Method: Prospective multicenter study enrolling patients undergoing mechanical ventilation for longer than 72 hours. TA samples were collected from patients with suspected ventilator-associated pneumonia, followed by PTC sampling. Quantitative cultures were performed on all samples. Patients were classified according to the presence or not of pneumonia, based on clinical and radiologic criteria, clinical course and autopsy findings. The cutoff points were ≥103 colony-forming units (cfu) per mL for PTC cultures; the TA cutoffs analyzed were ≥105 and ≥106 cfu/mL. Results: Of the 120 patients studied, 84 had diagnoses of pneumonia and 36 did not (controls). The sensitivity values for TA≥106, TA≥105, and PTC, respectively, were 54% (95% confidence interval [CI], 42%-64%), 71% (95% CI, 60%-81%), and 68% (95% CI, 57%-78%). The specificity values were 75% (95% CI, 58%-88%), 58% (95% CI, 41%-74%), and 75% (95% CI, 58%-88%), respectively. Staphylococcus aureus was the microorganism most frequently isolated in both TA and PTC samples, followed in frequency by Pseudomomonas aeruginosa in TA samples and Haemophilus influenzae in PTC samples. No significant differences were found between the sensitivity of TA≥105 and that of PTC, nor between the specificities of TA≥106 and PTC. Conclusions: No differences in the specificities of PTC and TA were found when a TA cutoff of ≥106 cfu/ml was used. Moreover, at a cutoff of ≥105 the sensitivity of TA was not statistically different from that of PTC. Quantitative cultures of TA can be considered acceptable for the diagnosis of ventilator-associated pneumonia.
Keywords:
Pneumonia
Mechanical ventilation
Tracheal aspirate
Objetivo: Estudiar la validez del aspirado traqueal (AT) con cultivos cuantitativos y compararla con el catéter telescopado (CTP) en el diagnóstico de la neumonía relacionada con la ventilación mecánica (NVM). Método: Estudio prospectivo y multicéntrico en el que se incluyó a pacientes sometidos a ventilación mecánica durante más de 72 h. A los pacientes con sospecha clínica de NVM se les realizaron AT y posteriormente CTP. A todas estas muestras se les practicó un cultivo cuantitativo. De acuerdo con criterios clínicos, radiológicos, de seguimiento y autópsicos se dividieron los pacientes en casos con neumonía y sin neumonía (controles). Se escogió como punto de corte para el CTP ≥ 103 unidades formadoras de colonias (ufc)/ml y para el AT se evaluó con ≥ 105 y > 106 ufc/ml, respectivamente. Resultados: Se estudió a 120 pacientes; se consideró que 84 presentaban neumonía y 36 no la presentaban (controles). La sensibilidad fue del 54% (intervalo de confianza [IC] del 95%, 42-64%), el 71% (IC del 95%, 60-81%) y el 68% (IC del 95%, 57-78%) para AT ≥ 106, AT ≥ 105 y CTP, respectivamente. Las especificidades encontradas fueron del 75% (IC del 95%, 58 - 88%), el 58% (IC del 95%, 41-74%) y el 75% (IC del 95%, 58 -88%), respectivamente. El organismo aislado más frecuentemente fue Staphylococcus aureus tanto por AT como por CTP, seguido por Pseudomomonas aeruginosa en AT y por Haemophilus influenzae en CTP. No se encontraron diferencias significativas entre la sensibilidad del AT ≥ 105 y del CTP, y tampoco con las especificidades del AT ≥ 106 y el CTP. Conclusiones: Cuando se utiliza un punto de corte de 106 ufc/ml o mayor para el AT en el diagnostico de la NVM se obtienen porcentajes de especificidad similares a los obtenidos con el CTP, y con el punto de corte 105 o mayor, porcentajes de sensibilidad aceptables. Los cultivos cuantitativos del AT pueden considerarse aceptables en el diagnóstico de la NVM.
Palabras clave:
Neumonía
Ventilación mecánica
Aspirado traqueal

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