Endotracheal aspirate and bronchoalveolar lavage fluid analysis: Interchangeable diagnostic modalities in suspected ventilator-associated pneumonia?

Journal of Clinical Microbiology

Volumn 52, Issue 10, 2014, Pages 3597-3604

  Scholte, Johannes B J ^a   Van Dessel, Helke A ^a   Linssen, Catharina F M ^b   Bergmans, Dennis C J J ^a   Savelkoul, Paul H M ^a   Roekaerts, Paul M H J ^a   Van Mook, Walther N K A ^a  

^a MAASTRICHT UNIVERSITY MEDICAL CENTER   (Netherlands)

^b Zuyderland Medical Centre   (Netherlands)

Author keywords

[No Author keywords available]

Indexed keywords

ACINETOBACTER; ARTICLE; BACTERIUM CULTURE; BACTERIUM IDENTIFICATION; BACTEROIDES FRAGILIS; BRONCHOALVEOLAR LAVAGE FLUID ANALYSIS; CITROBACTER FREUNDII; CONTROLLED STUDY; DIAGNOSTIC ACCURACY; DIAGNOSTIC TEST ACCURACY STUDY; ENTEROBACTER; ESCHERICHIA COLI; GRAM STAINING; HAEMOPHILUS INFLUENZAE; HUMAN; INTERMETHOD COMPARISON; KLEBSIELLA; MAJOR CLINICAL STUDY; MORAXELLA CATARRHALIS; NONHUMAN; PREDICTIVE VALUE; PROSPECTIVE STUDY; PROTEUS MIRABILIS; PROVIDENCIA RETTGERI; PSEUDOMONAS AERUGINOSA; RESPIRATORY TRACT EXAMINATION; SENSITIVITY AND SPECIFICITY; SERRATIA; STAPHYLOCOCCUS AUREUS; STENOTROPHOMONAS MALTOPHILIA; STREPTOCOCCUS PNEUMONIAE; TRACHEAL ASPIRATION PROCEDURE; VENTILATOR ASSOCIATED PNEUMONIA; BRONCHOALVEOLAR LAVAGE FLUID; COMPARATIVE STUDY; EVALUATION STUDY; INTENSIVE CARE UNIT; LABORATORY DIAGNOSIS; MICROBIOLOGICAL EXAMINATION; MICROBIOLOGY; PNEUMONIA, VENTILATOR-ASSOCIATED; PROCEDURES; TRACHEA; UNIVERSITY HOSPITAL;

BACTERIOLOGICAL TECHNIQUES; BRONCHOALVEOLAR LAVAGE FLUID; HOSPITALS, UNIVERSITY; HUMANS; INTENSIVE CARE UNITS; PNEUMONIA, VENTILATOR-ASSOCIATED; SPECIMEN HANDLING; TRACHEA;

EID: 84907167594     PISSN: 00951137     EISSN: 1098660X     Source Type: Journal    
DOI: 10.1128/JCM.01494-14     Document Type: Article

References (49)

1. Safdar N, Dezfulian C, Collard HR, Saint S. 2005. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit. Care Med. 33:2184-2193. http://dx.doi.org/10.1097/01.CCM.0000181731.53912.D9.
2. Melsen WG, Rovers MM, Groenwold RH, Bergmans DC, Camus C, Bauer TT, Hanisch EW, Klarin B, Koeman M, Krueger WA, Lacherade JC, Lorente L, Memish ZA, Morrow LE, Nardi G, van Nieuwenhoven CA, OKeefe GE, Nakos G, Scannapieco FA, Seguin P, Staudinger T, Topeli A, Ferrer M, Bonten MJ. 2013. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect. Dis. 13:665-671. http://dx .doi.org/10.1016/S1473-3099(13)70081-1.
3. Luna CM, Aruj P, Niederman MS, Garzón J, Violi D, Prignoni A, Ríos F, Baquero S, Gando S, Grupo Argentino de Estudio de la Neumonía Asociada al Respirador Group. 2006. Appropriateness and delay to initiate therapy in ventilator-associated pneumonia. Eur. Respir. J. 27:158-164. http://dx.doi.org/10.1183/09031936.06.00049105.
4. Kollef MH, Fraser VJ. 2001. Antibiotic resistance in the intensive care unit. Ann. Intern. Med. 134:298-314. http://dx.doi.org/10.7326/0003-4819-134-4-200102200-00014.
5. Novosel TJ, Hodge LA, Weireter LJ, Britt RC, Collins JN, Reed SF, Britt LD. 2012. Ventilator-associated pneumonia: depends on your definition. Am. Surg. 78:851-854.
6. Hunter JD. 2012. Ventilator associated pneumonia. BMJ 344:e3325. http://dx.doi.org/10.1136/bmj.e3325.
7. Medford AR, Husain SA, Turki HM, Millar AB. 2009. Diagnosis of ventilator-associated pneumonia. J. Crit. Care 24:473 e471-e476. http://dx.doi.org/10.1016/j.jcrc.2008.06.012.
8. Heyland DK, Cook DJ, Marshall J, Heule M, Guslits B, Lang J, Jaeschke R. 1999. The clinical utility of invasive diagnostic techniques in the setting of ventilator-associated pneumonia. Canadian Critical Care Trials Group. Chest 115:1076-1084.
9. Giantsou E, Liratzopoulos N, Efraimidou E, Panopoulou M, Alepopoulou E, Kartali-Ktenidou S, Manolas K. 2007. De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate. Intensive Care Med. 33:1533-1540. http://dx.doi.org/10.1007/s00134-007-0619-x.
10. de Jaeger A, Litalien C, Lacroix J, Guertin MC, Infante-Rivard C. 1999. Protected specimen brush or bronchoalveolar lavage to diagnose bacterial nosocomial pneumonia in ventilated adults: a meta-analysis. Crit. Care Med. 27:2548-2560. http://dx.doi.org/10.1097/00003246-199911000-00037.
11. Fagon JY, Chastre J, Wolff M, Gervais C, Parer-Aubas S, Stéphan F, Similowski T, Mercat A, Diehl JL, Sollet JP, Tenaillon A. 2000. Invasive and noninvasive strategies for management of suspected ventilatorassociated pneumonia. A randomized trial. Ann. Intern. Med. 132:621-630. http://dx.doi.org/10.7326/0003-4819-132-8-200004180-00004.
12. Baselski V. 1993. Microbiologic diagnosis of ventilator-associated pneumonia. Infect. Dis. Clin. North Am. 7:331-357.
13. Brusselaers N, Labeau S, Vogelaers D, Blot S. 2013. Value of lower respiratory tract surveillance cultures to predict bacterial pathogens in ventilator-associated pneumonia: systematic review and diagnostic test accuracy meta-analysis. Intensive Care Med. 39:365-375. http://dx.doi .org/10.1007/s00134-012-2759-x.
14. Bonten MJ, Weinstein RA. 1996. The role of colonization in the pathogenesis of nosocomial infections. Infect. Control Hosp. Epidemiol. 17: 193-200. http://dx.doi.org/10.2307/30142385.
15. Berton DC, Kalil AC, Teixeira PJ. 2012. Quantitative versus qualitative cultures of respiratory secretions for clinical outcomes in patients with ventilator-associated pneumonia. Cochrane Database Syst. Rev. 1:CD006482. http://dx.doi.org/10.1002/14651858.CD006482.pub2.
16. Masterton RG, Galloway A, French G, Street M, Armstrong J, Brown E, Cleverley J, Dilworth P, Fry C, Gascoigne AD, Knox A, Nathwani D, Spencer R, Wilcox M. 2008. Guidelines for the management of hospitalacquired pneumonia in the UK: report of the working party on hospitalacquired pneumonia of the British Society for Antimicrobial Chemotherapy. J. Antimicrob. Chemother. 62:5-34. http://dx.doi.org/10.1093/jac/dkn162.
17. American Thoracic Society, Infectious Diseases Society of America. 2005. Guidelines for the management of adults with hospital-acquired, ventilatorassociated, and healthcare-associated pneumonia. Am. J. Respir. Crit. Care Med. 171:388-416. http://dx.doi.org/10.1164/rccm.200405-644ST.
18. Muscedere J, Dodek P, Keenan S, Fowler R, Cook D, Heyland D, VAP Guidelines Committee and the Canadian Critical Care Trials Group. 2008. Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: prevention. J. Crit. Care 23:126-137. http://dx.doi.org/10.1016/j.jcrc.2007.11.014.
19. Raoof S, Baumann MH, Critical Care Societies Collaborative. 2014. An official multi-society statement: ventilator-associated events: the new definition. Crit. Care Med. 42:228-229. http://dx.doi.org/10.1097/CCM .0000000000000191.
20. Boots RJ, Phillips GE, George N, Faoagali JL. 2008. Surveillance culture utility and safety using low-volume blind bronchoalveolar lavage in the diagnosis of ventilator-associated pneumonia. Respirology 13:87-96. http://dx.doi.org/10.1111/j.1440-1843.2007.01211.x.
21. Luna CM, Sarquis S, Niederman M, Sosa A, Otaola M, Bailleau N, Vay CA, Famiglietti A, Irrazabal C, Capdevila A. 2013. Is an endotracheal routine cultures-based strategy the best way to prescribe antibiotics in ventilatorassociated pneumonia? Chest http://dx.doi.org/10.1378/chest.12-1477.
22. Linssen CF, Jacobs JA, Schouten JS, van Mook WN, Ramsay G, Drent M. 2008. Influence of antibiotic therapy on the cytological diagnosis of ventilator-associated pneumonia. Intensive Care Med. 34:865-872. http://dx.doi.org/10.1007/s00134-008-1015-x.
23. De Brauwer EI, Jacobs JA, Nieman F, Bruggeman CA, Wagenaar SS, Drent M. 2000. Cytocentrifugation conditions affecting the differential cell count in bronchoalveolar lavage fluid. Anal. Quant. Cytol. Histol. 22:416-422.
24. Timsit JF, Cheval C, Gachot B, Bruneel F, Wolff M, Carlet J, Regnier B. 2001. Usefulness of a strategy based on bronchoscopy with direct examination of bronchoalveolar lavage fluid in the initial antibiotic therapy of suspected ventilator-associated pneumonia. Intensive Care Med. 27:640-647. http://dx.doi.org/10.1007/s001340000840.
25. Allaouchiche B, Jaumain H, Dumontet C, Motin J. 1996. Early diagnosis of ventilator-associated pneumonia. Is it possible to define a cutoff value of infected cells in BAL fluid? Chest 110:1558-1565.
26. Torres A, El-Ebiary M. 2000. Bronchoscopic BAL in the diagnosis of ventilator-associated pneumonia. Chest 117:198S-202S. http://dx.doi.org/10.1378/chest.117.4-suppl-2.198S.
27. The Canadian Critical Care Trials Group. 2006. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N. Engl. J. Med. 355:2619-2630. http://dx.doi.org/10.1056/NEJMoa052904.
28. Landis JR, Koch GG. 1977. The measurement of observer agreement for categorical data. Biometrics 33:159-174. http://dx.doi.org/10.2307/2529310.
29. Blot F, Raynard B, Chachaty E, Tancrde C, Antoun S, Nitenberg G. 2000. Value of Gram stain examination of lower respiratory tract secretions for early diagnosis of nosocomial pneumonia. Am. J. Respir. Crit. Care Med. 162:1731-1737. http://dx.doi.org/10.1164/ajrccm.162 .5.9908088.
30. Goldberg AE, Malhotra AK, Riaz OJ, Aboutanos MB, Duane TM, Borchers CT, Martin N, Ivatury RR. 2008. Predictive value of bronchoalveolar lavage fluid Grams stain in the diagnosis of ventilator-associated pneumonia: a prospective study. J. Trauma 65:871-876, discussion 876-878. http://dx.doi.org/10.1097/TA.0b013e31818481e0.
31. Cook D, Mandell L. 2000. Endotracheal aspiration in the diagnosis of ventilator-associated pneumonia. Chest 117:195S-197S. http://dx.doi.org/10.1378/chest.117.4-suppl-2.195S.
32. Shin YM, Oh YM, Kim MN, Shim TS, Lim CM, Lee SD, Koh Y, Kim WS, Kim DS, Hong SB. 2011. Usefulness of quantitative endotracheal aspirate cultures in intensive care unit patients with suspected pneumonia. J. Korean Med. Sci. 26:865-869. http://dx.doi.org/10.3346/jkms.2011 .26.7.865.
33. Solé Violán J, Fernández JA, Benítez AB, Cardeñosa Cendrero JA, Rodríguez de Castro F. 2000. Impact of quantitative invasive diagnostic techniques in the management and outcome of mechanically ventilated patients with suspected pneumonia. Crit. Care Med. 28:2737-2741. http://dx.doi.org/10.1097/00003246-200008000-00009.
34. van Duijn PJ, Dautzenberg MJ, Oostdijk EA. 2011. Recent trends in antibiotic resistance in European ICUs. Curr. Opin. Crit. Care 17:658-665. http://dx.doi.org/10.1097/MCC.0b013e32834c9d87.
35. Liu C, Du Z, Zhou Q, Hu B, Li Z, Yu L, Xu T, Fan X, Yang J, Li J. 2014. Microscopic examination of intracellular organisms in bronchoalveolar lavage fluid for the diagnosis of ventilator-associated pneumonia: a prospective multi-center study. Chin. Med. J. (Engl.) 127:1808-1813.
36. Sirvent JM, Vidaur L, Gonzalez S, Castro P, de Batlle J, Castro A, Bonet A. 2003. Microscopic examination of intracellular organisms in protected bronchoalveolar mini-lavage fluid for the diagnosis of ventilatorassociated pneumonia. Chest 123:518-523. http://dx.doi.org/10.1378/chest.123.2.518.
37. Joos L, Chhajed PN, Wallner J, Battegay M, Steiger J, Gratwohl A, Tamm M. 2007. Pulmonary infections diagnosed by BAL: a 12-year experience in 1066 immunocompromised patients. Respir. Med. 101:93-97. http://dx.doi.org/10.1016/j.rmed.2006.04.006.
38. Rello J, Afonso E, Lisboa T, Ricart M, Balsera B, Rovira A, Valles J, Diaz E, FADO Project Investigators. 2012. A care bundle approach for prevention of ventilator-associated pneumonia. Clin. Microbiol. Infect. 19: 363-369. http://dx.doi.org/10.1111/j.1469-0691.2012.03808.x.
39. Li J, Xie D, Li A, Yue J. 2013. Oral topical decontamination for preventing ventilator-associated pneumonia: a systematic review and metaanalysis of randomized controlled trials. J. Hosp. Infect. 84:283-293. http://dx.doi.org/10.1016/j.jhin.2013.04.012.
40. Grgurich PE, Hudcova J, Lei Y, Sarwar A, Craven DE. 2013. Diagnosis of ventilator-associated pneumonia: controversies and working toward a gold standard. Curr. Opin. Infect. Dis. 26:140-150. http://dx.doi.org/10 .1097/QCO.0b013e32835ebbd0.
41. Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. 1991. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic "blind" bronchoalveolar lavage fluid. Am. Rev. Respir. Dis. 143:1121-1129. http://dx.doi.org/10.1164/ajrccm/143.5-Pt-1.1121.
42. Croce MA, Fabian TC, Mueller EW, Maish GO, III, Cox JC, Bee TK, Boucher BA, Wood GC. 2004. The appropriate diagnostic threshold for ventilator-associated pneumonia using quantitative cultures. J. Trauma 56: 931-934 discussion 934-936. http://dx.doi.org/10.1097/01.TA.0000127769 .29009.8C.
43. Lambotte O, Timsit JF, Garrouste-Orgeas M, Misset B, Benali A, Carlet J. 2002. The significance of distal bronchial samples with commensals in ventilator-associated pneumonia: colonizer or pathogen? Chest 122: 1389-1399. http://dx.doi.org/10.1378/chest.122.4.1389.
44. Wu CL, Yang DI, Wang NY, Kuo HT, Chen PZ. 2002. Quantitative culture of endotracheal aspirates in the diagnosis of ventilator-associated pneumonia in patients with treatment failure. Chest 122:662-668. http://dx.doi.org/10.1378/chest.122.2.662.
45. Wood AY, Davit AJ, II, Ciraulo DL, Arp NW, Richart CM, Maxwell RA, Barker DE. 2003. A prospective assessment of diagnostic efficacy of blind protective bronchial brushings compared to bronchoscope-assisted lavage, bronchoscope-directed brushings, and blind endotracheal aspirates in ventilator-associated pneumonia. J. Trauma 55:825-834. http://dx.doi .org/10.1097/01.TA.0000090038.26655.88.
46. Mentec H, May-Michelangeli L, Rabbat A, Varon E, Le Turdu F, Bleichner G. 2004. Blind and bronchoscopic sampling methods in suspected ventilator-associated pneumonia. A multicentre prospective study. Intensive Care Med. 30:1319-1326.
47. Mondi MM, Chang MC, Bowton DL, Kilgo PD, Meredith JW, Miller PR. 2005. Prospective comparison of bronchoalveolar lavage and quantitative deep tracheal aspirate in the diagnosis of ventilator associated pneumonia. J. Trauma 59:891-895; discussion 895-896. http://dx.doi.org/10 .1097/01.ta.0000188011.58790.e9.
48. El Solh AA, Akinnusi ME, Pineda LA, Mankowski CR. 2007. Diagnostic yield of quantitative endotracheal aspirates in patients with severe nursing home-acquired pneumonia. Crit. Care 11:R57. http://dx.doi.org/10.1186/cc5917.
49. Fujitani S, Cohen-Melamed MH, Tuttle RP, Delgado E, Taira Y, Darby JM. 2009. Comparison of semi-quantitative endotracheal aspirates to quantitative non-bronchoscopic bronchoalveolar lavage in diagnosing ventilator-associated pneumonia. Respir. Care 54:1453-1461.