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(Chest. 2002;122:662-668.)
© 2002 American College of Chest Physicians

Quantitative Culture of Endotracheal Aspirates in the Diagnosis of Ventilator-Associated Pneumonia in Patients With Treatment Failure*

Chien Liang Wu, MD; Dine Ie Yang, MS; Nai Yu Wang, BS; Hsu Tah Kuo, MD, FCCP and Pai Zan Chen, MD

* From the Division of Pulmonary and Critical Care Medicine (Drs. Wu, Kuo, and Chen), and Microbiology Section, Division of Medical Research (Dr. Yang and Ms. Wang), Mackay Memorial Hospital, Taipei, Taiwan.

Correspondence to: Chien Liang Wu, MD, Division of Pulmonary and Critical Care Medicine, Mackay Memorial Hospital. No. 92, 2, Chung-San North Rd, Taipei, Taiwan; e-mail: wuchienliang{at}sinamail.com

Study objective: To study the correlation of bacteriology between quantitative cultures of protected specimen brush (PSB), BAL, and quantitative endotracheal aspirate (QEA) in ventilator-associated pneumonia (VAP) patients with treatment failure.

Design: Prospective observational clinical study.

Setting: A 15-bed medical ICU of tertiary medical center.

Patients: Forty-eight patients receiving mechanical ventilation with clinical suspected VAP who had been treated with antibiotics for at least 72 h without improvement.

Intervention: QEA, PSB, and BAL were performed with patients receiving antibiotics. The diagnostic thresholds for QEA, PSB, and BAL were 105, 103, and 104 cfu/mL, respectively.

Measurements and results: Microbial culture findings were positive in 24 BAL samples (50%), in 23 PSB samples (48%), and in 28 QEA samples (58%). The correlations between of QEA vs PSB and QEA vs BAL were significant ({rho} = 0.567 and {rho} = 0.620, p < 0.01, respectively). The most commonly isolated microorganisms were Acinetobacter baumannii (27%), Staphylococcus aureus (24%), Stenotrophomonas maltophilia (15%), and Pseudomonas aeruginosa (10%). Using the predetermined criteria, bacterial pneumonia was diagnosed in 28 of 48 suspected VAP episodes based on PSB and/or BAL results. The diagnostic efficiency of QEA at threshold of 105 cfu/mL had a sensitivity of 92.8% and a specificity of 80%.

Conclusions: QEA correlated with PSB and BAL in patients with suspected VAP who responded poorly to the existent antibiotic treatment. QEA missed only two cases of bacterial pneumonia diagnosed by invasive PSB and/or BAL with acceptable sensitivity and specificity. More importantly, QEA is noninvasive and easily repeatable. Early use of QEA is helpful to clinical physicians in decision making with regard to antibiotics use.

Key Words: BAL • diagnosis • protected specimen brush • quantitative endotracheal aspirate • treatment failure • ventilator-associated pneumonia




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