TITLE

The Predictive Value of Preliminary Bacterial Colony Counts from Bronchoalveolar Lavage in Critically Ill Trauma Patients

AUTHOR(S)
Mueller, Eric W.; Wood, Christopher G.; Kelley, Mark S.; Boucher, Bradley A.; Fabian, Timothy C.; Croce, Martin A.
PUB. DATE
September 2003
SOURCE
American Surgeon;Sep2003, Vol. 69 Issue 9, p749
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
A common strategy for the diagnosis of ventilator-associated pneumonia (VAP) includes quantitative cultures from bronchoalveolar lavage (BAL). Often, empiric antibiotic therapy is initiated and continued until the final culture report. However, approximately 60 per cent of BAL cultures rule out VAP. Preliminary BAL results, obtained earlier, may identify these patients and allow early discontinuation of empiric antibiotics. This is desirable because unnecessary antibiotic therapy results in increased bacterial resistance, adverse drug events, and increased costs. The purpose of this study was to determine the value of preliminary BAL results for predicting final BAL results. A total of 1579 isolates from 868 BAL cultures over a 3-year period were analyzed. Preliminary and final colony counts for each isolate were categorized as either no growth (NG), insignificant (1-99,999 cfu/mL), or significant (≥100,000 cfu/mL). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of preliminary results were calculated based on individual isolates and individual BAL samples. The presence of concurrent antibiotic therapy was collected for all false-negative isolates. On preliminary report, there were 367 isolates with NG, 820 isolates with insignificant growth, and 392 isolates with significant growth. Overall preliminary culture results had a sensitivity of ∼90 per cent and specificity of >90 per cent for the presence of VAP. Preliminary culture results accurately predicted the presence or absence of VAP in 838 (96.5%) of the BALs performed. Individual isolates and BAL...
ACCESSION #
11063726

 

Related Articles

  • Mode of Evaluation Matters in Ventilator-Associated Pneumonia. Marshall, Adriene // Pulmonary Reviews;Jul2009, Vol. 14 Issue 7, p7 

    The article focuses on a study which suggested that effectiveness of bronchoalveolar lavage (BAL) over endotracheal aspirate (ETA) as a diagnostic tool for ventricular-associated pneumonia (VAP). Researcher A. Conway Morris and colleagues note that the study offers the first evaluation of the...

  • Cultura quantitativa de aspirado traqueal e lavado broncoalveolar no manejo de pacientes com pneumonia associada à ventilação mecânica: um ensaio clínico randomizado. de Amorim Corrêa, Ricardo; Michel Luna, Carlos; Versiani dos Anjos, José Carlos Fernandez; Alvarenga Barbosa, Eurípedes; de Rezende, Cláudia Juliana; Pereira Rezende, Adriano; Henrique Pereira, Fernando; da Costa Rocha, Manoel Otávio // Jornal Brasileiro de Pneumologia;nov/dez2014, Vol. 40 Issue 6, p643 

    Objective: To compare 28-day mortality rates and clinical outcomes in ICU patients with ventilator-associated pneumonia according to the diagnostic strategy used. Methods: This was a prospective randomized clinical trial. Of the 73 patients included in the study, 36 and 37 were randomized to...

  • Mixed Flora: Indication for Therapy or Early Warning Sign? Qureshi, Irfan; Kerwin, Andrew J.; McCarter, Yvette S.; Tepas, Joseph T. // American Surgeon;Aug2010, Vol. 76 Issue 8, p846 

    "Mixed flora" is a commonly returned result yielding not in either indication for therapy or identification of potential causative organisms. We sought to determine whether mixed flora (MF) was in fact a harbinger of impending pneumonia or a benign result that could be therapeutically ignored....

  • Evaluation of early mini-bronchoalveolar lavage in the diagnosis of health care-associated pneumonia: a prospective study. Lacroix, Guillaume; Prunet, Bertrand; Bordes, Julien; Cabon-Asencio, Nathalie; Asencio, Yves; Gaillard, Tiphaine; Pons, Sandrine; D'aranda, Erwan; Kerebel, Delphine; Meaudre, Eric; Goutorbe, Philippe // Critical Care;2013, Vol. 17 Issue 1, p1 

    Introduction: Health care-associated pneumonia (HCAP) has been proposed as a new category of respiratory infection to identify patients at risk of multidrug-resistant (MDR) pathogens. The American Thoracic Society's recommendation for HCAP treatment is to use broad-spectrum and multiple...

  • Comparison of Semi-Quantitative Endotracheal Aspirates to Quantitative Non-Bronchoscopic Bronchoalveolar Lavage in Diagnosing Ventilator-Associated Pneumonia. Fujitani, Shigeki; Cohen-Melamed, Mark H.; Tuttle, Raymond P.; Delgado, Edgar; Taira, Yasuhiko; Darby, Joseph M. // Respiratory Care;Nov2009, Vol. 54 Issue 11, p1453 

    BACKGROUND: Current strategies for diagnosing ventilator-associated pneumonia (VAP) favor the use of quantitative methods; however, semi-quantitative cultures of endotracheal aspirates are still commonly used. METHODS: The microbiological results of patients with suspected VAP who had both...

  • Influenza A Virus Exacerbates Staphylococcus aureus Pneumonia in Mice by Attenuating Antimicrobial Peptide Production. Robinson, Keven M.; McHugh, Kevin J.; Mandalapu, Sivanarayana; Clay, Michelle E.; Lee, Benjamin; Scheller, Erich V.; Enelow, Richard I.; Chan, Yvonne R.; Kolls, Jay K.; Alcorn, John F. // Journal of Infectious Diseases;Mar2014, Vol. 209 Issue 6, p865 

    Influenza A represents a significant cause of morbidity and mortality worldwide. Bacterial complications of influenza A confer the greatest risk to patients. TH17 pathway inhibition has been implicated as a mechanism by which influenza A alters bacterial host defense. Here we show that preceding...

  • IMAGES IN NEONATAL MEDICINE: Massive bacterial cell invasion and reactive type II pneumocytes in bronchoalveolar lavage fluid from a preterm neonate. Been, Jasper V.; Linssen, Catharina F. M.; Van Iwaarden, J. Freek; Zimmermann, Luc J. I. // Archives of Disease in Childhood -- Fetal & Neonatal Edition;Jul2007, Vol. 92 Issue 4, pF319 

    The article reports on the case of a preterm neonate whose bronchoalveolar lavage fluid was collected. The baby girl was diagnosed as having pneumonia, despite treatment with amoxicillin and gentamicin. Coagulase-negative staphylococci (CONS) were cultured from the fluid. Moreover, the author...

  • Recurrent pneumonia: Can it be parasite induced? Singh, Bhavna P.; Mamdapur, Anand B. // Community Acquired Infection;Jul-Sep2016, Vol. 3 Issue 3, p87 

    Strongyloides stercoralis is an intestinal nematode acquired primarily in the tropics, estimated to infect approximately 100 million people worldwide. Strongyloidiasis can be asymptomatic in many individuals or present in a variety of ways including acute infection, chronic infection,...

  • Blastomycosis: The Great Mimicker. Hakim, Hana; Apiwattanakul, Nopporn; Miyairi, Isao; Arnold, Sandra // Clinical Pediatrics;Dec2011, Vol. 50 Issue 12, p1156 

    The article presents a report that describes five patients with blastomycosis who presented from an endemic area with respiratory symptoms that suggest bacterial pneumonia. Despite several courses of antibiotics, there was a lack of clinical improvement, resulting in the need for bronchoscopy...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics