studious mood objective: This study was undertaken to determine whether tracheal aspirate agricultures correlate with protected specimen brush (PSB) refinements in the diagnosis of probable ventilator-associated pneumonia (VAP).

Design: Retrospective evaluation of 52 episodes of clinical pneumonia in 38 patients who underwent bronchoscopy and PSB as well as tracheal aspirate cultures

Setting: The application of mind took place in long-term, acute care hospital associated with a university medical instruct This hospital specializes in ventilator-assisted patients.

Patients: The patient population consisted of long-term ventilated patients (average ventilation time was 22 weeks; range, 4 weeks to 3 years) who currented with the clinical diagnosis of VAP (fever increased white offspring cell count, new infiltrate forward chest radiograph, and bronchorrhea). No patient had received antibiotics for the preceding 5 days at the time of bronchoscopy or tracheal aspirate culture

Measurements: The tracheal aspirate and PSB agriculture and sensitivities results.

Results: Identical organisms were win backed in both the tracheal aspirate and PSB cultivations in 36 of 52 episodes of VAP (69 percent) No organism was regained in either the tracheal aspirate or the PSB in 4 of 52 suspected episodes (8 percent) Positive bacterial refinements in the tracheal aspirate moreover not the PSB were establish in 8 of 52 (15 percent) episodes. In 3 of 52 episodes (6 percent) 1 isolate of pathogenic bacteria was rest on PSB and 2 were fix on tracheal aspirate cultures. However, all three isolates had the similar antibiotic sensitivities. In the final episode, the PSB refinement grew an organism that was not at hand in the tracheal aspirate agriculture (2 percent). When comparing the tracheal aspirate with the PSB the following were calculated: sensitivity =977 percent; specificity =50 percent; positive predictive value =913 percent; and negative predictive value =80 percent

Conclusion: Tracheal aspirate refinements correlate with PSB cultures in patients receiving long-term ventilation who have clinical pneumonia, and they can be used to direct initial antibiotic therapy in this cluster of patients. (Chest 1994: 106531-34)

BAL=broncoalveolar lavage; PBAL=transbronchoscopic balloon-tipped catheter; PSB=protect specimen brush; VAP=ventilator-assisted pneumonia

explanation words: bacteria; nosocomial pneumonia; pneumonia; defend ed specimen brush; sputum; tracheal aspirate; ventilation; ventilator-associated pneumonia

Ventilator-associated pneumonia (VAP) appears in 9 to 21 percent of patients with respiratory failure, and the mortality ranges from 55 to 71 percent[12] It can be found in up to 70 percent of patients who die of the adult respiratory distress syndrome[3] Appropriate antibiotic therapy significantly increases the survival of patients with VAP.[4,5] onward the other hand, broad-spectrum antibiotics given to patients who do not have VAP facilitate colonization and following infection with virulent organisms.[6] In single in kind study, the mortality in those ventilated patients who receive antibiotics before developing pneumonia was 83 percent compared with 48 percent if they did not receive antibiotics (p<001)[1]

Johanson et al[7] defined definite clinical pneumonia when a patient has radiographic evidence of a just discovered or progressive infiltrate, fever, leukocytosis, and feculent bronchorrhea.[7] In addition, Craven et al[2] require a fit sputum (more than 25 leukocyte les than 10 squamous epithelium cells) and a pullulation of a significant pathogen to make the diagnosis more specific. However, there are many causes that can mimic these clinical manifestations of nosocomial VAP leading to a high rate of misdiagnosis.[8]

The mostly reliable methods of determining probable nosocomial VAP are the patronizeed specimen brush (PSB), bronchoalveolar lavage (BAL), and the transbronchoscopic balloon-tipped catheter (PBAL).[8-10] Tracheal aspirate improvements have proven inaccurate in the diagnosis of VAP with a high false-positive rate. The sensitivity of tracheal aspirate agricultures in predicting probable VAP ranges from 58 to 100 percent while the specificity ranges from 14 to 100 percent[11] greatest in number of the studies comparing the various techniques in the diagnosis of VAP were mannersed in acute care intensive care units.[11] We plant out to see if the above principles still applied in the setting of a long-term acute care hospital specializing in ventilator-assisted patients.

arrangements and Materials

Patient Population

The application of mind was conducted at the University of southern Florida associated Vencor [center dot] Tampa Hospital in Tampa, Fla. The records of 38 mechanically ventilated patients who had 52 episodes of suspected VAP between August 1992 and April 1993 were retrospectively reviewed. The duration of ventilation ranged from 1 month to 3 years (average ventilation time was 22 weeks). The average age was 72 years (range, 56 to 84 pars) and the male to female ratio was 16:22 The entrance criteria were as follows: (1) clinical suspicion of pneumonia with febrile affection of 38.3 [degrees] C or greater and a strange or progressive infiltrate on radiograph with either a leukocytosis >10000/[mmsup3] or macroscopically feculent tracheal aspirate; and (2) no patient had received antibiotics for at least 5 days before the storm of signs and symptoms of VAP. All PSB and tracheal aspirate agricultures were obtained before antibiotic therapy was initiated.

...