Quantitative tracheal lavage versus bronchoscopic protected specimen brush for the diagnosis of nosocomial pneumonia in mechanically ventilated patients
No gold standard method exists for the diagnosis of ventilator-associated pneumonia despite the availability of multiple techniques. A prospective, crossover study was performed on mechanically ventilated patients meeting with suspected pneumonia. Eighteen paired samples were obtained on 15 patients...
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| Veröffentlicht in: | The American journal of surgery 2003-12, Vol.186 (6), p.591-596 |
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| creator | Aucar, John A Bongera, Miguel Phillips, Jeffrey O Kamath, Ravishankar Metzler, Michael H |
| description | No gold standard method exists for the diagnosis of ventilator-associated pneumonia despite the availability of multiple techniques.
A prospective, crossover study was performed on mechanically ventilated patients meeting with suspected pneumonia. Eighteen paired samples were obtained on 15 patients, comparing the results of quantitative tracheal lavage (QTL) to bronchoscopic protected brush specimen (PSB) by quantitative culture and gram stain examination.
The sensitivity, specificity, positive and negative predictive values, and accuracy are affected by the growth density threshold selected, and whether the same organisms are expected by both methods. There is a significant relationship between QTL and PSB (
P = 0.0048;
R = 0.632), gram stain and PSB (
P |
| doi_str_mv | 10.1016/j.amjsurg.2003.08.005 |
| format | Article |
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A prospective, crossover study was performed on mechanically ventilated patients meeting with suspected pneumonia. Eighteen paired samples were obtained on 15 patients, comparing the results of quantitative tracheal lavage (QTL) to bronchoscopic protected brush specimen (PSB) by quantitative culture and gram stain examination.
The sensitivity, specificity, positive and negative predictive values, and accuracy are affected by the growth density threshold selected, and whether the same organisms are expected by both methods. There is a significant relationship between QTL and PSB (
P = 0.0048;
R = 0.632), gram stain and PSB (
P <0.001;
R = 0.791), and gram stain and QTL (
P = 0.0125;
R = 0.575), by Spearman rank order correlation.
QTL may have a role for diagnosing and directing treatment of ventilator-associated pneumonia, allowing reservation of bronchoscopic PSB for secondary, high risk and refractory cases.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2003.08.005</identifier><identifier>PMID: 14672763</identifier><identifier>CODEN: AJSUAB</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Accuracy ; Adult ; Aged ; Antibiotics ; Biological and medical sciences ; Bronchoalveolar Lavage Fluid - microbiology ; Bronchoscopy ; Case-Control Studies ; Catheters ; Colony Count, Microbial ; Cross Infection - diagnosis ; Cross Infection - etiology ; Cross-Over Studies ; Diagnosis ; E coli ; Female ; Humans ; Infections ; Influenza ; Intensive care ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Mechanical ventilation ; Medical sciences ; Methods ; Middle Aged ; Mortality ; Ostomy ; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques ; Patients ; Pneumonia ; Pneumonia, Bacterial - diagnosis ; Pneumonia, Bacterial - etiology ; Pneumonia, Bacterial - microbiology ; Predictive Value of Tests ; Prospective Studies ; Respiration, Artificial - adverse effects ; Respiratory system ; Sensitivity and Specificity ; Suctioning ; Teaching hospitals ; Trachea - microbiology ; Tracheal lavage</subject><ispartof>The American journal of surgery, 2003-12, Vol.186 (6), p.591-596</ispartof><rights>2003 Excerpta Medica Inc.</rights><rights>2004 INIST-CNRS</rights><rights>Copyright Elsevier Limited Jan 2003</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c447t-381b581b28714142395a807b91e3fef15fa0e64b4801392807ca2bece210c3563</citedby><cites>FETCH-LOGICAL-c447t-381b581b28714142395a807b91e3fef15fa0e64b4801392807ca2bece210c3563</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1444601084?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>309,310,314,780,784,789,790,3550,23930,23931,25140,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15378871$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14672763$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aucar, John A</creatorcontrib><creatorcontrib>Bongera, Miguel</creatorcontrib><creatorcontrib>Phillips, Jeffrey O</creatorcontrib><creatorcontrib>Kamath, Ravishankar</creatorcontrib><creatorcontrib>Metzler, Michael H</creatorcontrib><title>Quantitative tracheal lavage versus bronchoscopic protected specimen brush for the diagnosis of nosocomial pneumonia in mechanically ventilated patients</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>No gold standard method exists for the diagnosis of ventilator-associated pneumonia despite the availability of multiple techniques.
A prospective, crossover study was performed on mechanically ventilated patients meeting with suspected pneumonia. Eighteen paired samples were obtained on 15 patients, comparing the results of quantitative tracheal lavage (QTL) to bronchoscopic protected brush specimen (PSB) by quantitative culture and gram stain examination.
The sensitivity, specificity, positive and negative predictive values, and accuracy are affected by the growth density threshold selected, and whether the same organisms are expected by both methods. There is a significant relationship between QTL and PSB (
P = 0.0048;
R = 0.632), gram stain and PSB (
P <0.001;
R = 0.791), and gram stain and QTL (
P = 0.0125;
R = 0.575), by Spearman rank order correlation.
QTL may have a role for diagnosing and directing treatment of ventilator-associated pneumonia, allowing reservation of bronchoscopic PSB for secondary, high risk and refractory cases.</description><subject>Accuracy</subject><subject>Adult</subject><subject>Aged</subject><subject>Antibiotics</subject><subject>Biological and medical sciences</subject><subject>Bronchoalveolar Lavage Fluid - microbiology</subject><subject>Bronchoscopy</subject><subject>Case-Control Studies</subject><subject>Catheters</subject><subject>Colony Count, Microbial</subject><subject>Cross Infection - diagnosis</subject><subject>Cross Infection - etiology</subject><subject>Cross-Over Studies</subject><subject>Diagnosis</subject><subject>E coli</subject><subject>Female</subject><subject>Humans</subject><subject>Infections</subject><subject>Influenza</subject><subject>Intensive care</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Mechanical ventilation</subject><subject>Medical sciences</subject><subject>Methods</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Ostomy</subject><subject>Pathology. Cytology. Biochemistry. Spectrometry. 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Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques</topic><topic>Patients</topic><topic>Pneumonia</topic><topic>Pneumonia, Bacterial - diagnosis</topic><topic>Pneumonia, Bacterial - etiology</topic><topic>Pneumonia, Bacterial - microbiology</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Respiration, Artificial - adverse effects</topic><topic>Respiratory system</topic><topic>Sensitivity and Specificity</topic><topic>Suctioning</topic><topic>Teaching hospitals</topic><topic>Trachea - microbiology</topic><topic>Tracheal lavage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Aucar, John A</creatorcontrib><creatorcontrib>Bongera, Miguel</creatorcontrib><creatorcontrib>Phillips, Jeffrey O</creatorcontrib><creatorcontrib>Kamath, Ravishankar</creatorcontrib><creatorcontrib>Metzler, Michael H</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aucar, John A</au><au>Bongera, Miguel</au><au>Phillips, Jeffrey O</au><au>Kamath, Ravishankar</au><au>Metzler, Michael H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Quantitative tracheal lavage versus bronchoscopic protected specimen brush for the diagnosis of nosocomial pneumonia in mechanically ventilated patients</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2003-12-01</date><risdate>2003</risdate><volume>186</volume><issue>6</issue><spage>591</spage><epage>596</epage><pages>591-596</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><coden>AJSUAB</coden><abstract>No gold standard method exists for the diagnosis of ventilator-associated pneumonia despite the availability of multiple techniques.
A prospective, crossover study was performed on mechanically ventilated patients meeting with suspected pneumonia. Eighteen paired samples were obtained on 15 patients, comparing the results of quantitative tracheal lavage (QTL) to bronchoscopic protected brush specimen (PSB) by quantitative culture and gram stain examination.
The sensitivity, specificity, positive and negative predictive values, and accuracy are affected by the growth density threshold selected, and whether the same organisms are expected by both methods. There is a significant relationship between QTL and PSB (
P = 0.0048;
R = 0.632), gram stain and PSB (
P <0.001;
R = 0.791), and gram stain and QTL (
P = 0.0125;
R = 0.575), by Spearman rank order correlation.
QTL may have a role for diagnosing and directing treatment of ventilator-associated pneumonia, allowing reservation of bronchoscopic PSB for secondary, high risk and refractory cases.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>14672763</pmid><doi>10.1016/j.amjsurg.2003.08.005</doi><tpages>6</tpages></addata></record> |
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| subjects | Accuracy Adult Aged Antibiotics Biological and medical sciences Bronchoalveolar Lavage Fluid - microbiology Bronchoscopy Case-Control Studies Catheters Colony Count, Microbial Cross Infection - diagnosis Cross Infection - etiology Cross-Over Studies Diagnosis E coli Female Humans Infections Influenza Intensive care Investigative techniques, diagnostic techniques (general aspects) Male Mechanical ventilation Medical sciences Methods Middle Aged Mortality Ostomy Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques Patients Pneumonia Pneumonia, Bacterial - diagnosis Pneumonia, Bacterial - etiology Pneumonia, Bacterial - microbiology Predictive Value of Tests Prospective Studies Respiration, Artificial - adverse effects Respiratory system Sensitivity and Specificity Suctioning Teaching hospitals Trachea - microbiology Tracheal lavage |
| title | Quantitative tracheal lavage versus bronchoscopic protected specimen brush for the diagnosis of nosocomial pneumonia in mechanically ventilated patients |
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