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Neither questions nor answers, just original data

Servei de Pneumologia, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain

To the Editor:

We have read with interest the letter by Ewig 1 in relation to our article 2. According to his opinion, our study raises an unproductive debate about the usefulness of bronchoscopic sampling techniques in ventilator-associated pneumonia (VAP).

As it is well known, most of the studies dealing with the diagnostic efficacy of bronchoscopic sampling techniques in VAP include a large percentage of patients already on antibiotics when the procedure is carried out. Owing to the different nature of the antibiotic treatment used in these series, the variable "prior antibiotics" suppose an important bias for the interpretation of the microbiological results. Furthermore, only a few studies provide adequate information concerning the nature of the previous antibiotic regimens and, consequently, as it has been recently emphasised 3 in this setting, the interpretation of the microbiological data is usually complex.

We designed our study in order to obtain prospective data that could demonstrate the effect of an adequate antibiotic regimen on susceptible strains obtained by protected specimen brush technique, before antibiotic treatment and at different periods of time after the introduction of the antibiotic. So far, very few studies have used a similar approach 4. Our results demonstrate that some bacterial species appear to be highly vulnerable to antibiotics (Streptococcus pneumoniae, Haemophilus influenzae), whereas other organisms (Pseudomonas aeruginosa, Acinetobacter baumanii, Staphylococcus aureus) are still viable 48–72 h after starting an active antibiotic treatment.

We do not believe that our data can be taken as an argument in the controversy about the usefulness of bronchoscopic sampling techniques in ventilator-associated pneumonia. They just demonstrate that in some cases, basically in the early onset ventilator-associated pneumonia, a very short course of an appropriate antibiotic can provide false-negative results, and this has to be taken into account when defining the therapeutic strategy. In addition, it is possible that a similar antibiotic effect can be observed when using samples obtained by more simple sampling methods, such as endotracheal aspirates, but this, of course, has to be confirmed.

References

1. Ewig S. Questions with inconclusive answers. Eur Respir J 2002;20:1064–1065.[Free Full Text]
2. Prats E, Dorca J, Pujol M, et al. Effects of antibiotics on protected specimen brush sampling in ventilator-associated pneumonia. Eur Respir J 2002;19:944–951.[Abstract/Free Full Text]
3. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867–903.[Abstract/Free Full Text]
4. Montravers P, Fagon JY, Chastre J, et al. Follow-up protected specimen brushes to assess treatment in nosocomial pneumonia. Am Rev Respir Dis 1993;147:33–34.

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