Endotracheal Aspirate and Bronchoalveolar Lavage Fluid Analysis: Interchangeable Diagnostic Modalities in Suspected Ventilator-Associated Pneumonia?

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Abstract

Authoritative guidelines state that the diagnosis of ventilator-associated pneumonia (VAP) can be established using either endotracheal aspirate (ETA) or bronchoalveolar lavage fluid (BALF) analysis, thereby suggesting that their results are considered to be in accordance. Therefore, the results of ETA Gram staining and semiquantitative cultures were compared to the results from a paired ETA-BALF analysis. Different thresholds for the positivity of ETAs were assessed. This was a prospective study of all patients who underwent bronchoalveolar lavage for suspected VAP in a 27-bed university intensive care unit during an 8-year period. VAP was diagnosed when >= 2% of the BALF cells contained intracellular organisms and/or when BALF quantitative culture revealed >= 10(4) CFU/ml of potentially pathogenic microorganisms. ETA Gram staining and semiquantitative cultures were compared to the results from paired BALF analysis by Cohen's kappa coefficients. VAP was suspected in 311 patients and diagnosed in 122 (39%) patients. In 288 (93%) patients, the results from the ETA analysis were available for comparison. Depending on the threshold used and the diagnostic modality, VAP incidences varied from 15% to 68%. For the diagnosis of VAP, the most accurate threshold for positivity of ETA semiquantitative cultures was moderate or heavy growth, whereas the optimal threshold for BALF Gram staining was >= 1 microorganisms per high power field. The Cohen's kappa coefficients were 0.22, 0.31, and 0.60 for ETA and paired BALF Gram stains, cultures, and BALF Gram stains, respectively. Since the ETA and BALF Gram stains and cultures agreed only fairly, they are probably not interchangeable for diagnosing VAP.

Original languageEnglish
Pages (from-to)3597-3604
Number of pages8
JournalJournal of Clinical Microbiology
Volume52
Issue number10
DOIs
Publication statusPublished - Oct 2014

Keywords

  • INTENSIVE-CARE-UNIT
  • INTRACELLULAR ORGANISMS
  • MICROSCOPIC EXAMINATION
  • ANTIBIOTIC-RESISTANCE
  • NOSOCOMIAL PNEUMONIA
  • TRACHEAL ASPIRATE
  • RANDOMIZED-TRIAL
  • METAANALYSIS
  • CULTURES
  • THERAPY

Cite this

@article{aaf1da275da14bd5b572c2592856061e,
title = "Endotracheal Aspirate and Bronchoalveolar Lavage Fluid Analysis: Interchangeable Diagnostic Modalities in Suspected Ventilator-Associated Pneumonia?",
abstract = "Authoritative guidelines state that the diagnosis of ventilator-associated pneumonia (VAP) can be established using either endotracheal aspirate (ETA) or bronchoalveolar lavage fluid (BALF) analysis, thereby suggesting that their results are considered to be in accordance. Therefore, the results of ETA Gram staining and semiquantitative cultures were compared to the results from a paired ETA-BALF analysis. Different thresholds for the positivity of ETAs were assessed. This was a prospective study of all patients who underwent bronchoalveolar lavage for suspected VAP in a 27-bed university intensive care unit during an 8-year period. VAP was diagnosed when >= 2{\%} of the BALF cells contained intracellular organisms and/or when BALF quantitative culture revealed >= 10(4) CFU/ml of potentially pathogenic microorganisms. ETA Gram staining and semiquantitative cultures were compared to the results from paired BALF analysis by Cohen's kappa coefficients. VAP was suspected in 311 patients and diagnosed in 122 (39{\%}) patients. In 288 (93{\%}) patients, the results from the ETA analysis were available for comparison. Depending on the threshold used and the diagnostic modality, VAP incidences varied from 15{\%} to 68{\%}. For the diagnosis of VAP, the most accurate threshold for positivity of ETA semiquantitative cultures was moderate or heavy growth, whereas the optimal threshold for BALF Gram staining was >= 1 microorganisms per high power field. The Cohen's kappa coefficients were 0.22, 0.31, and 0.60 for ETA and paired BALF Gram stains, cultures, and BALF Gram stains, respectively. Since the ETA and BALF Gram stains and cultures agreed only fairly, they are probably not interchangeable for diagnosing VAP.",
keywords = "INTENSIVE-CARE-UNIT, INTRACELLULAR ORGANISMS, MICROSCOPIC EXAMINATION, ANTIBIOTIC-RESISTANCE, NOSOCOMIAL PNEUMONIA, TRACHEAL ASPIRATE, RANDOMIZED-TRIAL, METAANALYSIS, CULTURES, THERAPY",
author = "J.B.J. Scholte and {van Dessel}, H.A. and C.F.M. Linssen and D.C.J.J. Bergmans and P.H.M. Savelkoul and P.M.H.J. Roekaerts and {van Mook}, W.N.K.A.",
year = "2014",
month = "10",
doi = "10.1128/JCM.01494-14",
language = "English",
volume = "52",
pages = "3597--3604",
journal = "Journal of Clinical Microbiology",
issn = "0095-1137",
publisher = "American Society for Microbiology",
number = "10",

}

TY - JOUR

T1 - Endotracheal Aspirate and Bronchoalveolar Lavage Fluid Analysis: Interchangeable Diagnostic Modalities in Suspected Ventilator-Associated Pneumonia?

AU - Scholte, J.B.J.

AU - van Dessel, H.A.

AU - Linssen, C.F.M.

AU - Bergmans, D.C.J.J.

AU - Savelkoul, P.H.M.

AU - Roekaerts, P.M.H.J.

AU - van Mook, W.N.K.A.

PY - 2014/10

Y1 - 2014/10

N2 - Authoritative guidelines state that the diagnosis of ventilator-associated pneumonia (VAP) can be established using either endotracheal aspirate (ETA) or bronchoalveolar lavage fluid (BALF) analysis, thereby suggesting that their results are considered to be in accordance. Therefore, the results of ETA Gram staining and semiquantitative cultures were compared to the results from a paired ETA-BALF analysis. Different thresholds for the positivity of ETAs were assessed. This was a prospective study of all patients who underwent bronchoalveolar lavage for suspected VAP in a 27-bed university intensive care unit during an 8-year period. VAP was diagnosed when >= 2% of the BALF cells contained intracellular organisms and/or when BALF quantitative culture revealed >= 10(4) CFU/ml of potentially pathogenic microorganisms. ETA Gram staining and semiquantitative cultures were compared to the results from paired BALF analysis by Cohen's kappa coefficients. VAP was suspected in 311 patients and diagnosed in 122 (39%) patients. In 288 (93%) patients, the results from the ETA analysis were available for comparison. Depending on the threshold used and the diagnostic modality, VAP incidences varied from 15% to 68%. For the diagnosis of VAP, the most accurate threshold for positivity of ETA semiquantitative cultures was moderate or heavy growth, whereas the optimal threshold for BALF Gram staining was >= 1 microorganisms per high power field. The Cohen's kappa coefficients were 0.22, 0.31, and 0.60 for ETA and paired BALF Gram stains, cultures, and BALF Gram stains, respectively. Since the ETA and BALF Gram stains and cultures agreed only fairly, they are probably not interchangeable for diagnosing VAP.

AB - Authoritative guidelines state that the diagnosis of ventilator-associated pneumonia (VAP) can be established using either endotracheal aspirate (ETA) or bronchoalveolar lavage fluid (BALF) analysis, thereby suggesting that their results are considered to be in accordance. Therefore, the results of ETA Gram staining and semiquantitative cultures were compared to the results from a paired ETA-BALF analysis. Different thresholds for the positivity of ETAs were assessed. This was a prospective study of all patients who underwent bronchoalveolar lavage for suspected VAP in a 27-bed university intensive care unit during an 8-year period. VAP was diagnosed when >= 2% of the BALF cells contained intracellular organisms and/or when BALF quantitative culture revealed >= 10(4) CFU/ml of potentially pathogenic microorganisms. ETA Gram staining and semiquantitative cultures were compared to the results from paired BALF analysis by Cohen's kappa coefficients. VAP was suspected in 311 patients and diagnosed in 122 (39%) patients. In 288 (93%) patients, the results from the ETA analysis were available for comparison. Depending on the threshold used and the diagnostic modality, VAP incidences varied from 15% to 68%. For the diagnosis of VAP, the most accurate threshold for positivity of ETA semiquantitative cultures was moderate or heavy growth, whereas the optimal threshold for BALF Gram staining was >= 1 microorganisms per high power field. The Cohen's kappa coefficients were 0.22, 0.31, and 0.60 for ETA and paired BALF Gram stains, cultures, and BALF Gram stains, respectively. Since the ETA and BALF Gram stains and cultures agreed only fairly, they are probably not interchangeable for diagnosing VAP.

KW - INTENSIVE-CARE-UNIT

KW - INTRACELLULAR ORGANISMS

KW - MICROSCOPIC EXAMINATION

KW - ANTIBIOTIC-RESISTANCE

KW - NOSOCOMIAL PNEUMONIA

KW - TRACHEAL ASPIRATE

KW - RANDOMIZED-TRIAL

KW - METAANALYSIS

KW - CULTURES

KW - THERAPY

U2 - 10.1128/JCM.01494-14

DO - 10.1128/JCM.01494-14

M3 - Article

VL - 52

SP - 3597

EP - 3604

JO - Journal of Clinical Microbiology

JF - Journal of Clinical Microbiology

SN - 0095-1137

IS - 10

ER -