Chest
Clinical InvestigationsIs Protected Specimen Brush a Reproducible Method to Diagnose ICU-Acquired Pneumonia
Section snippets
Methods
The study was designed to compare the results of two PSB procedures performed in the same lung subsegment on mechanically ventilated patients with suspected IAP to assess the accuracy of this method for routine diagnosis in clinics.
Results
Forty-two episodes of suspected IAP in 26 patients were analyzed. Table 1 indicates the results of PSB1 and PSB2 for each patient (type and number of growing bacteria) and the final diagnosis. Before the new septic signs associated with a clinical suspicion of nosocomial pneumonia, 15 patients (24 episodes) received antibiotic therapy for other reasons (patients with COPD with bronchial superinfection [n = 7], peritonitis [n = 8], catheter infection [n = 2], antibiotic prophylaxis for digestive
Discussion
Protected specimen brush is considered to be one of the main diagnostic methods for diagnosing IAP. The exactness of the classic diagnostic threshold of 103 cfu/ml has been established comparing PSB culture results with histologic and bacteriologic lung cultures.8 Utilization, in routine practice, of this precise threshold assumes a correct in vivo reliability of the PSB culture which is demonstrated in vitro.9
Our results indicate that even with maximal care to carry out the PSB procedures with
ACKNOWLEDGMENT
We are indebted to Dr. I. Cunningham (Indianapolis) for helpful assistance in reviewing the manuscript.
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2001, ChestCitation Excerpt :Overall, this technique has about 82% sensitivity and 89% specificity.19 However, the repeatability of this procedure in the same patient is not perfect, and quantitative discordance may be considerable.2021 Another problem with this technique and others already discussed is that colony counts fall in patients previously treated with antibiotics.2223
Manuscript received August 4; revision accepted December 3.