VALIDATION OF DIFFERENT TECHNIQUES FOR THE DIAGNOSIS OF VENTILATOR-ASSOCIATED PNEUMONIA - COMPARISON WITH IMMEDIATE POSTMORTEM PULMONARY BIOPSY

被引:247
作者
TORRES, A
ELEBIARY, M
PADRO, L
GONZALEZ, J
DELABELLACASA, JP
RAMIREZ, J
XAUBET, A
FERRER, M
RODRIGUEZROISIN, R
机构
[1] UNIV BARCELONA, HOSP CLIN BARCELONA, SERV ALLERGIA RESP, BARCELONA, SPAIN
[2] UNIV BARCELONA, HOSP CLIN BARCELONA, MICROBIOL SERV, BARCELONA, SPAIN
[3] UNIV BARCELONA, HOSP CLIN BARCELONA, SERV ANAT PATHOL, BARCELONA, SPAIN
关键词
D O I
10.1164/ajrccm.149.2.8306025
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
To assess the accuracy of clinical parameters for the diagnosis of ventilator-associated (VA) pneumonia, as well as the diagnostic value of several invasive techniques, such as protected specimen brush (PSB), bronchoalveolar lavage (BAL), fiberoptic bronchial aspirates (FBAS), and percutaneous lung needle aspiration (PLNA), we compared the results of these techniques with the histopathology of immediate postmortem pulmonary biopsies, considered the ''gold standard'' reference test. We studied 30 mechanically ventilated patients (age 52 +/- 21 yr; mechanical ventilation period 9 +/- 7 days) who died in an intensive care unit. All patients received prior antibiotic treatment. The following procedures were performed immediately after death: bilateral PSB, BAL, FBAS, and PLNA, as well as bilateral minithoracotomies to obtain pulmonary biopsies as close as possible to the area sampled with the other techniques. According to the histopathology 18 patients had pneumonia and 12 did not. The presence of fever (sensitivity 55%, specificity 58%), purulent secretions (sensitivity 83%, specificity 33%), and chest radiograph infiltrates (sensitivity 78%, specificity 42%) could not differentiate in all instances presence from absence of pneumonia. Quantitative bacterial cultures of lung biopsies using 10(3) cfu/g as a cutoff point had low sensitivity (40%) and low specificity (45%) and could not differentiate the histologic absence or presence of pneumonia. Considering the histopathology of pulmonary biopsies as a gold standard, we found the following sensitivities for PSB, BAL, FBAS, acid PLNA: 36, 50, 44, and 25%. The specificities were 50, 45, 48, and 79%, respectively. The sensitivities and specificities of different invasive techniques are much lower than those reported in clinical studies. The poor diagnostic value of microbiologic cultures of different techniques was probably due to the presence of prior antibiotic treatment. The only significant correlation among quantitative cultures of coincident microorganisms was found between PSB and BAL. Our results suggest that, in presence of prior antibiotic treatment, the microbiology and histopathology of lung biopsy cultures are not good gold standards for diagnosing VA pneumonia. Furthermore, we found an overlap between clinical, microbiologic, and histopathologic diagnosis of VA pneumonia. Diagnostic techniques performed upon patients receiving antibiotic treatment are of poor help in managing VA pneumonia.
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页码:324 / 331
页数:8
相关论文
共 23 条
[1]   DIAGNOSIS OF NOSOCOMIAL BACTERIAL PNEUMONIA IN ACUTE, DIFFUSE LUNG INJURY [J].
ANDREWS, CP ;
COALSON, JJ ;
SMITH, JD ;
JOHANSON, WG .
CHEST, 1981, 80 (03) :254-258
[2]  
BALOWS A, 1991, MANUAL CLIN MICROBIO, P209
[3]   MULTIPLE ORGAN SYSTEM FAILURE AND INFECTION IN ADULT RESPIRATORY-DISTRESS SYNDROME [J].
BELL, RC ;
COALSON, JJ ;
SMITH, JD ;
JOHANSON, WG .
ANNALS OF INTERNAL MEDICINE, 1983, 99 (03) :293-298
[4]  
BORDERON E, 1981, REV FR MAL RESPIR, V9, P229
[5]  
CHASTRE J, 1984, AM REV RESPIR DIS, V130, P924
[6]  
CHASTRE J, 1992, American Review of Respiratory Disease, V145, pA542
[7]   BACTERIOLOGIC DIAGNOSIS OF ACUTE PNEUMONIA - COMPARISON OF SPUTUM, TRANSTRACHEAL ASPIRATES, AND LUNG ASPIRATES [J].
DAVIDSON, M ;
TEMPEST, B ;
PALMER, DL .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1976, 235 (02) :158-163
[8]   COMPARISON OF NONBRONCHOSCOPIC BRONCHOALVEOLAR LAVAGE TO OPEN LUNG-BIOPSY FOR THE BACTERIOLOGIC DIAGNOSIS OF PULMONARY INFECTIONS IN MECHANICALLY VENTILATED PATIENTS [J].
GAUSSORGUES, P ;
PIPERNO, D ;
BACHMANN, P ;
BOYER, F ;
JEAN, G ;
GERARD, M ;
LEGER, P ;
ROBERT, D .
INTENSIVE CARE MEDICINE, 1989, 15 (02) :94-98
[9]   SELECTION AND INTERPRETATION OF DIAGNOSTIC-TESTS AND PROCEDURES - PRINCIPLES AND APPLICATIONS [J].
GRINER, PF ;
MAYEWSKI, RJ ;
MUSHLIN, AI ;
GREENLAND, P .
ANNALS OF INTERNAL MEDICINE, 1981, 94 (04) :553-+
[10]  
HILL JD, 1976, J THORAC CARDIOV SUR, V71, P64