Comparison of Semi-Quantitative Endotracheal Aspirates to Quantitative Non-Bronchoscopic Bronchoalveolar Lavage in Diagnosing Ventilator-Associated Pneumonia

摘要: BACKGROUND: Current strategies for diagnosing ventilator-associated pneumonia (VAP) favor the use of quantitative methods; however, semi-quantitative cultures endotracheal aspirates are still commonly used. METHODS: The microbiological results patients with suspected VAP who had both non-bronchoscopic bronchoalveolar lavage (BAL) and aspirate obtained within 24 hours each other were retrospectively reviewed compared, using a threshold ≥ 104 colony-forming units/mL as reference standard. RESULTS: 256 paired identified. Concordance between (any growth pathogens) BAL was complete in 58.2% completely discordant 23.8%. sensitivity specificity 65.4% 56.1%, which improved to 81.2% 61.9% when antibiotic management decisions considered analysis. Twenty-six that falsely negative pathogens, 61.5% these demonstrating non-fermenting Gram-negative rods or methicillin-resistant Staphylococcus aureus (MRSA) on BAL. Overall, 45 (17.5%) among entire cohort false positive cultures, 19 (42.2%) MRSA. CONCLUSIONS: Semi-quantitative poorly concordant via Although performance improves treatment is considered, guiding therapy basis may result failure identify potentially multiple-drug-resistant would also tend promote excessive usage. Our data support VAP.