Concordance between two methods of bronchoalveolar lavage for the microbiological diagnosis of pneumonia in mechanically ventilated patients
Keywords:
pneumonia/etiology, respiration, artificial, diagnostic techniques and procedures, microbiological techniques, bronchoalveolar lavage
Abstract
Introduction. Microbiological diagnosis of pneumonia allows the optimal use of antibiotics in mechanically ventilated patients. That is why samples of bronchoscopic bronchoalveolar lavage had been quantitatively cultivated, but this procedure is not always possible.Objective. To evaluate the microbiological concordance between respiratory samples obtained by non-bronchoscopic protected bronchoalveolar lavage compared to the bronchoscopic ones, and to find out whether concordance was affected by previous use of antibiotics or the time of pneumonia Honest
Materials and methods. Prospective study conducted at Hospital Universitario San Vicente de Paúl, in 38 patients with suspected pneumonia in mechanical ventilation. Bronchoalveolar lavage specimens were taken by two methods, the traditional one and non-bronchoscopic bronchoalveolar lavage, using a telescoping preformed tip catheter (Balcath®). All samples were processed using conventional microbiologic protocols.
Results. Considering flexible bronchoscopy with bronchoalveolar lavage as the gold standard, cultures allowed the identification of at least one respiratory pathogen in 60.5% of cases. Diagnostic agreement was achieved in 82% of patients and 79% of microbiologic isolates. Using the Cohen´s kappa coefficient, general concordance between both methods was 0.76 [0.60-0.93]; but in those who received previously antibiotics was 0.26 [0.05-0.48], versus 1.0 in those who did not (p<0.0001). Concordance did not differ significantly when cases of early or late pneumonia were compared.
Conclusions. Concordance between non-bronchoscopic and bronchoscopic bronchoalveolar lavage is good in mechanically ventilated patients with pneumonia. However, the use of antibiotics previously, but not the time of pneumonia presentation, significantly decreases that concordance.
Downloads
Download data is not yet available.
References
1. Heyland DK, Cook DJ, Griffith L, Keenan SP, Brun- Buisson C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. The Canadian Critical Trials Group. Am J Respir Crit Care Med. 1999;159:1249-56.
2. Bercault N, BoulainT. Mortality rate attributable to ventilator-associated nosocomial pneumonia in an adult intensive care unit: a prospective casecontrol study. Crit Care Med. 2001;29:2303-9.
3. Fagon JY, Chastre AJ, Hance AJ, Montravers P, Novara A, Gilbert C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med. 1993;94:281-8.
4. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165:867-903.
5. Fagon JY, Chastre J, Wolff M, Gervais C, Parer- Aubas S, Stéphan F, et al. Invasive and non-invasive strategies for management of suspected ventilator associated pneumonia: a randomized trial. Ann Intern Med. 2000;132:621-30. 6. The Canadian Critical Care Trials Group. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med. 2006;21:2619-30.
7. Torres A, El-Ebiary M, Padró L, González J, de la Bellacasa JP, Ramírez J. Validation of different techniques for the diagnosis of ventilator-associated pneumonia. Comparison with immediate postmortem pulmonary biopsy. Am J Respir Crit Care Med.1994; 149:324-31.
8. Marik P, Brown W. A comparison of bronchoscopic Vs. blind protected specimen brush sampling in patients with suspected ventilator-associated pneumonia. Chest. 1995;108:203-7.
9. Torres A, El-Ebiary M. Invasive diagnostic techniques for pneumonia: protected specimen brush, bronchoalveolar lavage and lung biopsy methods. Infect Dis Clin North Am. 1998;12;701-22.
10. Pittet D, Harbarth S. What techniques for diagnosis of ventilator-associated pneumonia? Lancet. 1998; 352:83-4. 11. Casetta M, Blot F, Antoun S, Leclercq B, Tancrède C, Doyon F, et al. Diagnosis of nosocomial pneumonia in cancer patients undergoing mechanical ventilation: a prospective comparison of the plugged telescoping catheter with the protected specimen brush. Chest. 1999;115:1641-5.
12. Heyland DK, Cook DJ, Marshall J, Heule M, Guslits B, Lang J, et al. The clinical utility of invasive diagnostic techniques in the setting of ventilator-associated pneumonia. Canadian Care Trials Group. Chest. 1999;115:1076-84. 13. Grossman R, Fein A. Evidence-based assessment of diagnostic test for ventilator associated pneumonia: executive summary. Chest. 2000;117:177S-81.
14. American Thoracic Society. Clinical role of bronchoalveolar lavage in adults with pulmonary disease. Am J Respir Crit Care Med. 1990;142:481-86.
15. Kahn FW, Jones JM. Analysis of bronchoalveolar lavage specimens from immunocompromised patients with a protocol applicable in the microbiology laboratory. J Clin Microbiol. 1988;26:1150-5.
16. Mayhall CG. Ventilator-associated pneumonia or not? Contemporary diagnosis. Emerg Infect Dis. 2001;7:200-4.
17. Souweine B, Veber B, Bedos JP, Gachot B, Dombret MC, Regnier B, et al. Diagnostic accuracy of protected specimen brush and bronchoalveolar lavage in nosocomial pneumonia: Impact of previous antimicrobial treatments. Crit Care Med. 1998;26:236-44.
18. Campbell GD. Blinded invasive diagnostic procedures in ventilator-associated pneumonia. Chest. 2000;117:207S-11.
19. Woske HG, Röding T, Schulz I, Lode H. Ventilatorassociated pneumonia in a surgical intensive care unit: epidemiology, etiology and comparison of three bronchoscopic methods for microbiological specimen sampling. Crit Care. 2001;5:167-73.
20. Chastre J, Fagon JY, Bornet-Lecso M, Calvat S, Dombret MC, al Khani R, et al. Evaluation of bronchoscopic techniques for the diagnosis of nosocomial pneumonia. Am J Respir Crit Care Med. 1995;152:231-40.
21. Pham LH, Brun-Buisson C, Legrand P, Rauss A, Verra F, Brochard L, et al. Diagnosis of nosocomial pneumonia in mechanically ventilated patients. Comparison of a plugged telescoping catheter with the protected specimen brush. Am Rev Respir Dis. 1991;143:1055-61.
22. Wearden PD, Chendrasekhar A, Timberlake GA. Comparison of nonbronchoscopic techniques with bronchoscopic brushing in the diagnosis of ventilatorassociated pneumonia. J Trauma. 1996;41:703-7.
23. Bello S, Tejada A, Chacón E, Villuendas MC, Senar A, Gascon M, et al. “Blind” protected specimen brush ing versus bronchoscopic techniques in the aetiolological diagnosis of ventilator-associated pneumonia. Eur Respir J. 1996;9:1494-9.
24. Jordá R, Parras F, Ibañez J, Reina J, Bregada J, Raurich JM. Diagnosis of nosocomial pneumonia in mechanically ventilated patients by the blind protected telescoping catheter. Intensive Care Med. 1993; 19: 377-82.
25. Papazian L, Martin C, Meric B, Dumon JF, Gouin F. A reappraisal of blind bronchial sampling in the microbiologic diagnosis of nosocomial bronchopneumonia. A comparative study in ventilated patients. Chest. 1993;103:236-42.
26. Middleton RM III, Huff W, Brickey DA, Kirkpatrick MB. Comparison of quantitative cultures to semiquantitative loop cultures of bronchoscopic protected specimen brush samples. Chest. 1996; 109:1204-9.
27. Leal-Noval SR, Alfaro-Rodríguez E, Murillo-Cabeza F, Garnacho-Montero J, Rey-Pérez J, Muñoz- Sánchez MA. Diagnostic value of the blind brush in mechanically ventilated patients with nosocomial pneumonia. Intensive Care Med. 1992;18:410-4.
28. Wood AY, Davit AJ II, Ciraulo DL, Arp NW, Richart CM, Maxwell RA, et al. A prospective assessment of diagnostic efficacy of blind protective bronchial brushings compared with bronchoscope-assisted lavage, bronchoscope-directed brushings, and blind endotracheal aspirates in ventilator-associated pneumonia. J Trauma. 2003; 55:825-34.
29. Torres A, Puig de la Bellacasa J, Rodríguez-Roisin R, Jiménez deAnta MT, Agusti-Vidal A. Diagnostic value of telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia using the Metras catheter. Am Rev Respir Dis.1988;138:117-20.
30. Kollef MH, Bock KR, Richards RD, Hearns ML. The safety and diagnostic accuracy of minibronchoalveolar lavage in patients suspected of ventilator-associated pneumonia. Ann Intern Med. 1995;122:743-8.
31. Levy H. Comparison of Ballard catheter bronchoalveolar lavage with bronchoscopic bronchoalveolar lavage. Chest. 1994;106:1753-8.
32. Timsit JF, Misset B, Renaud B, Goldstein FW, Carlet J. Effect of previous antimicrobial therapy on the accuracy of the main procedures used to diagnose nosocomial pneumonia in patients who are using ventilation. Chest. 1995;108:1036-40.
33. Solé Violán J, Rodríguez de Castro F, Caminero J, Bordes A, Manzano JL. Comparative efficacy of broncoalveolar lavage and telescoping plugged catheter in the diagnosis of pneumonia in mechanically ventilated patients. Chest. 1993;103:386-90.
34. Torres A, Martos A, Puig de la Bellacasa J, Ferrer M, el-Ebiary M, González J, et al. Specificity of endotracheal aspiration, protected specimen brush, and broncoalveolar lavage in mechanically ventilated patients. Am Rev Respir Dis. 1993;147:952-7.
35. Marik PE, Careau P. A comparison of minibronchoalveolar lavage and blind-protected specimen brush sampling in ventilated patients with suspected pneumonia. J Crit Care. 1998;13:67-72.
36. Sirvent JM, Vidaur L, González S, Castro P, de Batle J, Castro A, et al. Microscopic examination of intracellular organisms in protected bronchoalveolar mini-lavage fluid for the diagnosis of ventilator-associated pneumonia. Chest. 2003;123:518-23.
37. De Jaeger A, Litalien C, Lacroix J, Guertin MC, Infante-Rivard C. Protected specimen brush or bronchoalveolar lavage to diagnose bacterial nosocomial pneumonia in ventilated adults: a meta-analysis. Crit Care Med. 1999;27:2548-60.
38. Dotson RG, Pingleton SK. The effect of antibiotic therapy on recovery of intracellular bacteria from bronchoalveolar lavage in suspected ventilator-associated nosocomial pneumonia. Chest. 1993;103:541-6.
39. Trouillet JL, Chastre J, Vuagnat A, Joly-Guillou ML, Combaux D, Dombret MC, et al. Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med. 1998; 157:531-9.
40. Fridkin SK, Lawton R, Edwards JR, Tenover FC, McGowan JE, Gaynes RP, et al. Monitoring antimicrobial use and resistance: comparison with a national benchmark on reducing vancomycin use and vancomycin- resistant enterococci. Emerg Infect Dis. 2002;8:702-7.
41. Chastre J. Evolving problems with resistant pathogens. Clin Microbiol Infect. 2008;14:3-14.
42. Rello J, Ausina V, Ricart M, Castella J, Prats G. Impact of previous antimicrobial therapy on the etiology and outcome of ventilator-associated pneumonia. Chest. 1993;104:1230-5.
43. Lynch JP. Hospital-acquired pneumonia. Risk factors, microbiology, and treatment. Chest. 2001;119:373S-84.
44. Ewig S, Bauer T, Torres A. The pulmonary physician in critical care. Nosocomial pneumonia. Thorax. 2002;57:366-71.
2. Bercault N, BoulainT. Mortality rate attributable to ventilator-associated nosocomial pneumonia in an adult intensive care unit: a prospective casecontrol study. Crit Care Med. 2001;29:2303-9.
3. Fagon JY, Chastre AJ, Hance AJ, Montravers P, Novara A, Gilbert C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med. 1993;94:281-8.
4. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165:867-903.
5. Fagon JY, Chastre J, Wolff M, Gervais C, Parer- Aubas S, Stéphan F, et al. Invasive and non-invasive strategies for management of suspected ventilator associated pneumonia: a randomized trial. Ann Intern Med. 2000;132:621-30. 6. The Canadian Critical Care Trials Group. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med. 2006;21:2619-30.
7. Torres A, El-Ebiary M, Padró L, González J, de la Bellacasa JP, Ramírez J. Validation of different techniques for the diagnosis of ventilator-associated pneumonia. Comparison with immediate postmortem pulmonary biopsy. Am J Respir Crit Care Med.1994; 149:324-31.
8. Marik P, Brown W. A comparison of bronchoscopic Vs. blind protected specimen brush sampling in patients with suspected ventilator-associated pneumonia. Chest. 1995;108:203-7.
9. Torres A, El-Ebiary M. Invasive diagnostic techniques for pneumonia: protected specimen brush, bronchoalveolar lavage and lung biopsy methods. Infect Dis Clin North Am. 1998;12;701-22.
10. Pittet D, Harbarth S. What techniques for diagnosis of ventilator-associated pneumonia? Lancet. 1998; 352:83-4. 11. Casetta M, Blot F, Antoun S, Leclercq B, Tancrède C, Doyon F, et al. Diagnosis of nosocomial pneumonia in cancer patients undergoing mechanical ventilation: a prospective comparison of the plugged telescoping catheter with the protected specimen brush. Chest. 1999;115:1641-5.
12. Heyland DK, Cook DJ, Marshall J, Heule M, Guslits B, Lang J, et al. The clinical utility of invasive diagnostic techniques in the setting of ventilator-associated pneumonia. Canadian Care Trials Group. Chest. 1999;115:1076-84. 13. Grossman R, Fein A. Evidence-based assessment of diagnostic test for ventilator associated pneumonia: executive summary. Chest. 2000;117:177S-81.
14. American Thoracic Society. Clinical role of bronchoalveolar lavage in adults with pulmonary disease. Am J Respir Crit Care Med. 1990;142:481-86.
15. Kahn FW, Jones JM. Analysis of bronchoalveolar lavage specimens from immunocompromised patients with a protocol applicable in the microbiology laboratory. J Clin Microbiol. 1988;26:1150-5.
16. Mayhall CG. Ventilator-associated pneumonia or not? Contemporary diagnosis. Emerg Infect Dis. 2001;7:200-4.
17. Souweine B, Veber B, Bedos JP, Gachot B, Dombret MC, Regnier B, et al. Diagnostic accuracy of protected specimen brush and bronchoalveolar lavage in nosocomial pneumonia: Impact of previous antimicrobial treatments. Crit Care Med. 1998;26:236-44.
18. Campbell GD. Blinded invasive diagnostic procedures in ventilator-associated pneumonia. Chest. 2000;117:207S-11.
19. Woske HG, Röding T, Schulz I, Lode H. Ventilatorassociated pneumonia in a surgical intensive care unit: epidemiology, etiology and comparison of three bronchoscopic methods for microbiological specimen sampling. Crit Care. 2001;5:167-73.
20. Chastre J, Fagon JY, Bornet-Lecso M, Calvat S, Dombret MC, al Khani R, et al. Evaluation of bronchoscopic techniques for the diagnosis of nosocomial pneumonia. Am J Respir Crit Care Med. 1995;152:231-40.
21. Pham LH, Brun-Buisson C, Legrand P, Rauss A, Verra F, Brochard L, et al. Diagnosis of nosocomial pneumonia in mechanically ventilated patients. Comparison of a plugged telescoping catheter with the protected specimen brush. Am Rev Respir Dis. 1991;143:1055-61.
22. Wearden PD, Chendrasekhar A, Timberlake GA. Comparison of nonbronchoscopic techniques with bronchoscopic brushing in the diagnosis of ventilatorassociated pneumonia. J Trauma. 1996;41:703-7.
23. Bello S, Tejada A, Chacón E, Villuendas MC, Senar A, Gascon M, et al. “Blind” protected specimen brush ing versus bronchoscopic techniques in the aetiolological diagnosis of ventilator-associated pneumonia. Eur Respir J. 1996;9:1494-9.
24. Jordá R, Parras F, Ibañez J, Reina J, Bregada J, Raurich JM. Diagnosis of nosocomial pneumonia in mechanically ventilated patients by the blind protected telescoping catheter. Intensive Care Med. 1993; 19: 377-82.
25. Papazian L, Martin C, Meric B, Dumon JF, Gouin F. A reappraisal of blind bronchial sampling in the microbiologic diagnosis of nosocomial bronchopneumonia. A comparative study in ventilated patients. Chest. 1993;103:236-42.
26. Middleton RM III, Huff W, Brickey DA, Kirkpatrick MB. Comparison of quantitative cultures to semiquantitative loop cultures of bronchoscopic protected specimen brush samples. Chest. 1996; 109:1204-9.
27. Leal-Noval SR, Alfaro-Rodríguez E, Murillo-Cabeza F, Garnacho-Montero J, Rey-Pérez J, Muñoz- Sánchez MA. Diagnostic value of the blind brush in mechanically ventilated patients with nosocomial pneumonia. Intensive Care Med. 1992;18:410-4.
28. Wood AY, Davit AJ II, Ciraulo DL, Arp NW, Richart CM, Maxwell RA, et al. A prospective assessment of diagnostic efficacy of blind protective bronchial brushings compared with bronchoscope-assisted lavage, bronchoscope-directed brushings, and blind endotracheal aspirates in ventilator-associated pneumonia. J Trauma. 2003; 55:825-34.
29. Torres A, Puig de la Bellacasa J, Rodríguez-Roisin R, Jiménez deAnta MT, Agusti-Vidal A. Diagnostic value of telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia using the Metras catheter. Am Rev Respir Dis.1988;138:117-20.
30. Kollef MH, Bock KR, Richards RD, Hearns ML. The safety and diagnostic accuracy of minibronchoalveolar lavage in patients suspected of ventilator-associated pneumonia. Ann Intern Med. 1995;122:743-8.
31. Levy H. Comparison of Ballard catheter bronchoalveolar lavage with bronchoscopic bronchoalveolar lavage. Chest. 1994;106:1753-8.
32. Timsit JF, Misset B, Renaud B, Goldstein FW, Carlet J. Effect of previous antimicrobial therapy on the accuracy of the main procedures used to diagnose nosocomial pneumonia in patients who are using ventilation. Chest. 1995;108:1036-40.
33. Solé Violán J, Rodríguez de Castro F, Caminero J, Bordes A, Manzano JL. Comparative efficacy of broncoalveolar lavage and telescoping plugged catheter in the diagnosis of pneumonia in mechanically ventilated patients. Chest. 1993;103:386-90.
34. Torres A, Martos A, Puig de la Bellacasa J, Ferrer M, el-Ebiary M, González J, et al. Specificity of endotracheal aspiration, protected specimen brush, and broncoalveolar lavage in mechanically ventilated patients. Am Rev Respir Dis. 1993;147:952-7.
35. Marik PE, Careau P. A comparison of minibronchoalveolar lavage and blind-protected specimen brush sampling in ventilated patients with suspected pneumonia. J Crit Care. 1998;13:67-72.
36. Sirvent JM, Vidaur L, González S, Castro P, de Batle J, Castro A, et al. Microscopic examination of intracellular organisms in protected bronchoalveolar mini-lavage fluid for the diagnosis of ventilator-associated pneumonia. Chest. 2003;123:518-23.
37. De Jaeger A, Litalien C, Lacroix J, Guertin MC, Infante-Rivard C. Protected specimen brush or bronchoalveolar lavage to diagnose bacterial nosocomial pneumonia in ventilated adults: a meta-analysis. Crit Care Med. 1999;27:2548-60.
38. Dotson RG, Pingleton SK. The effect of antibiotic therapy on recovery of intracellular bacteria from bronchoalveolar lavage in suspected ventilator-associated nosocomial pneumonia. Chest. 1993;103:541-6.
39. Trouillet JL, Chastre J, Vuagnat A, Joly-Guillou ML, Combaux D, Dombret MC, et al. Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med. 1998; 157:531-9.
40. Fridkin SK, Lawton R, Edwards JR, Tenover FC, McGowan JE, Gaynes RP, et al. Monitoring antimicrobial use and resistance: comparison with a national benchmark on reducing vancomycin use and vancomycin- resistant enterococci. Emerg Infect Dis. 2002;8:702-7.
41. Chastre J. Evolving problems with resistant pathogens. Clin Microbiol Infect. 2008;14:3-14.
42. Rello J, Ausina V, Ricart M, Castella J, Prats G. Impact of previous antimicrobial therapy on the etiology and outcome of ventilator-associated pneumonia. Chest. 1993;104:1230-5.
43. Lynch JP. Hospital-acquired pneumonia. Risk factors, microbiology, and treatment. Chest. 2001;119:373S-84.
44. Ewig S, Bauer T, Torres A. The pulmonary physician in critical care. Nosocomial pneumonia. Thorax. 2002;57:366-71.
How to Cite
1.
Vélez L, Loaiza N, Gaviria LM, Maya MA, Rueda ZV, Correa LT, et al. Concordance between two methods of bronchoalveolar lavage for the microbiological diagnosis of pneumonia in mechanically ventilated patients. biomedica [Internet]. 2008 Dec. 1 [cited 2024 May 18];28(4):551-6. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/60
Some similar items:
- Jenniffer Rodiño, Nataly Rincón, Yudy Alexandra Aguilar, Zulma Vanessa Rueda, Mariana Herrera, Lázaro Agustín Vélez, Microscopic diagnosis of Pneumocystis jirovecii pneumonia in bronchoalveolar lavage and oropharyngeal wash samples of immunocompromised patients with pneumonia , Biomedica: Vol. 31 No. 2 (2011)
- Ariel A. Arteta, Luis F. Arias, Claudia E. Cadavid , Ziehl-Neelsen stain in the pathology laboratory: Performance and diagnostic aid for mycobacteria in bronchoalveolar lavage , Biomedica: Vol. 42 No. 3 (2022)
Issue
Section
Original articles
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
