Chest
Critical CareBlood Cultures Have Limited Value in Predicting Severity of Illness and as a Diagnostic Tool in Ventilator-Associated Pneumonia
Section snippets
Materials and Methods
The study was conducted in the Critical Care Unit of the Hospital de Clínicas José de San Martín, University of Buenos Aires, Argentina from April 1, 1992 to July 31, 1997. This is a 15-bed medical (noncoronary) and surgical unit in a 500-bed teaching hospital that serves as both a referral center and a first-line hospital. Intubated patients receiving mechanical ventilation who developed a new or progressive infiltrate on chest radiograph after being in the hospital for > 72 h were eligible
Results
During the 64-month period of study, 162 consecutive episodes of clinically defined VAP were studied. BAL fluid was collected and blood cultures performed in all cases; however, the BAL technique was able to confirm infection microbiologically in 90 episodes. Ten episodes occurred in patients who had had ≥ 1 prior episodes of VAP; these subsequent episodes involved other areas and developed at least 9 days after the patient had improved from the prior episode. Each pneumonia episode in a single
Discussion
Pneumonia is a common complication of mechanical ventilation, but uncertainties about diagnosis and how to identify the likely etiologic pathogen remain a common clinical problem. Several authors have used the results of the culture of bronchoscopically obtained specimens (protected specimen brush and BAL cultures) both to confirm the diagnosis and to identify the etiologic pathogenic microorganisms, based on the data from experimental and clinical studies.251011121314 However, several recent
References (27)
Diagnosis of ventilator associated pneumonia
Infect Dis Clin North Am
(1993)- et al.
Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia
Chest
(1997) - et al.
The diagnosis of ventilator-associated pneumonia: a comparison of histologic, microbiologic, and clinical criteria
Chest
(1997) - et al.
Bacteremic nosocomial pneumonia: a 7-year experience in one institution
Chest
(1995) - et al.
Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies; a consensus statement
Am J Respir Crit Care Med
(1995) - et al.
Bacteremic nosocomial pneumonia
Am Rev Respir Dis
(1984) - et al.
Bacteriologic diagnosis of nosocomial pneumonia in primates: usefulness of the protected specimen brush
Am Rev Respir Dis
(1982) - et al.
Nosocomial pneumonia in patients receiving mechanical ventilation: prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques
Am Rev Respir Dis
(1989) - et al.
Diagnosis of nosocomial pneumonia in intubated, intensive care unit patients
Am Rev Respir Dis
(1987) Are routine blood cultures effective in the evaluation of patients clinically diagnosed to have nosocomial pneumonia?
Am Surg
(1996)
Nosocomial pneumonia and mortality among patients in intensive care units
JAMA
Prospective evaluation of protected specimen brush for the diagnosis of pulmonary infections in ventilated patients
Am Rev Respir Dis
Diagnostic value of quantitative cultures of bronchoalveolar lavage and telescoping plugged catheters in mechanical ventilated patients with bacterial pneumonia
Am Rev Respir Dis
Cited by (100)
Management of Ventilator-Associated Pneumonia: Guidelines
2024, Infectious Disease Clinics of North AmericaManagement of Ventilator-Associated Pneumonia: Guidelines
2018, Clinics in Chest MedicineCitation Excerpt :The rationale for blood cultures is that although bacteremic VAP is uncommon, the presence of bacteremia can provide definitive evidence of the infecting organism and consequently can improve the accuracy of using appropriate antibiotics. Also, if a pathogen not usually causing respiratory tract infection is isolated, it can point to a nonrespiratory source needing investigation.9,10 Because of the high prevalence of multidrug resistant (MDR) pathogens causing VAP, there is no debate about the need to perform respiratory cultures to guide antibiotic therapy for VAP.
Colonization of oropharynx and lower respiratory tract in critical patients: Risk of ventilator-associated pneumonia
2018, Archives of Oral BiologyImpact of Oral Chlorhexidine on Bloodstream Infection in Critically Ill Patients: Systematic Review and Meta-Analysis of Randomized Controlled Trials
2017, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :However, the link between pneumonia and BSI is not robust. The sensitivity of blood cultures to diagnose lower respiratory tract infection is less than 25%, and when positive, the microorganism may originate from an extrapulmonary source, such as the urinary tract and vascular devices.32–34 This information was supported by the analysis presented here, which found that 62% and 35% of microorganisms causing BSI in the test and control groups, respectively, generally did not cause pneumonia (eg, coagulase-negative staphylococci, enterococci, and anaerobes).
Bacteremic pneumonia caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: Appropriateness of empirical treatment matters
2016, Journal of Microbiology, Immunology and Infection
For editorial comment see page 859.