Chest
Volume 91, Issue 2, February 1987, Pages 233-236
Journal home page for Chest

Clinical Investigations
Use of the Protected Specimen Brush in Patients with Endotracheal or Tracheostomy Tubes

https://doi.org/10.1378/chest.91.2.233Get rights and content

Twenty-one patients on mechanical ventilators for greater than 48 hours who had new localized infiltrates were evaluated using a quantitative culture technique of the involved lung compared to the non-involved lung. Based on the clinical course, response to antibiotics, or subsequent analysis of pathologic specimens, eight patients were felt to have acute bacterial pneumonia, while the remaining 13 were felt to have an alternative cause of their infiltrate. Cultures of the protected brush specimen of the involved lung in all eight cases of bacterial pneumonia had one or more organisms grown at a greater than 100 colony forming units (cfu) per ml while only one of the 13 cases of nonpneumonia had a culture from the involved area having greater than 100 cfu per ml (p <0.001). The non-involved area always grew fewer organisms than the involved area, and in 16 cases, there was no growth from the specimen obtained from the noninvolved area.

Section snippets

Material and Methods

Patients were recruited from those seen in the medical and surgical intensive care units at the University of Cincinnati Medical Center and the Veterans Administration Medical Center, Cincinnati. Patients were eligible for study if they had been intubated with either an endotracheal tube or tracheostomy tube for at least 48 hours, if they had a new, localized infiltrate on chest roentgenogram either on a normal chest roentgenogram or in addition to diffuse infiltrate already present, as in

Results

We studied a total of 21 patients. The underlying condition in each case is shown in Table 1. All eight pneumonia patients had a clinical course and chest roentgenogram consistent with bacterial pneumonia. In all cases, there was resolution of the localized infiltrate on chest roentgenogram temporally related to the use of antibiotics. In the other 13 cases (nonpneumonia), an alternate diagnosis was arrived at for the cause of the localized infiltrate. Six patients appeared to have the adult

Discussion

The degree of accuracy of diagnosis of pneumonia often depends on the particular patient. Several methods have been proposed for making the diagnosis of pneumonia, many trading safety for accuracy. For example, obtaining an expectorated sputum sample is an inexpensive, innocuous method of providing a specimen for culture of respiratory tract pathogens. However, the frequent contamination of the specimen with oral flora causes significant difficulty in interpreting sputum culture results.8 The

ACKNOWLEDGMENT

The authors wish to thank Jean Walden for help with culturing specimens, Dr. Robert Loudon for his review, and Naomi Sims for secretarial help in preparing this manuscript.

References (12)

  • WG Johanson et al.

    Nosocomial respiratory infections with gram-negative bacilli: the significance of colonization of the respiratory tract

    Ann Intern Med

    (1972)
  • GL French et al.

    Insignificance of colonic bacteria in the sputum of patients in a new ICU

    Crit Care Med

    (1979)
  • JH Higuchi et al.

    Bacteriologic diagnosis of nosocomial pneumonia in primates: usefulness of the protected specimen brush

    Am Rev Respir Dis

    (1982)
  • N Wimberley et al.

    A fiberoptic bronchoscopy technique to obtain uncontaminated lower airway secretions for bacterial culture

    Am Rev Respir Dis

    (1979)
  • JL Fleiss

    Statistical methods for rates and proportions

    (1981)
There are more references available in the full text version of this article.

Cited by (124)

  • Convergent alteration of lung tissue microbiota and tumor cells in lung cancer

    2022, iScience
    Citation Excerpt :

    It was suggested that microbiota might be involved in cancer at multiple levels including predisposing conditions, initiation, progression, susceptibility to host immune response, and response to therapy (Dzutsev et al., 2017). Lung was thought to be sterile as no culturable bacteria were available from lower respiratory tract samples (Baughman et al., 1987; Thorpe et al., 1987). However, with the development of culture-independent techniques, especially the widespread application of next-generation sequencing, it was uncovered that lung is also the home to diverse communities of microbes (Dickson and Huffnagle,2015).

  • Biologics and the lung: TSLP and other epithelial cell-derived cytokines in asthma

    2017, Pharmacology and Therapeutics
    Citation Excerpt :

    This ensures that the airways are exposed to a huge array of allergens, microbes and particulate matter. Once thought of as a sterile environment in health, the distal airway and lung have been shown to host a wide variety of microbes, now referred to as lung microbiome (Baughman et al., 1987; Charlson et al., 2011; Erb-Downward et al., 2011). This has been elucidated through advanced molecular techniques such as real time-polymerase chain reaction.

  • The microbiome at the pulmonary alveolar niche and its role in Mycobacterium tuberculosis infection

    2015, Tuberculosis
    Citation Excerpt :

    By contrast, medical science had long assumed that the lung was a sterile environment unless perturbed by respiratory pathogens. Indeed, many culture-based investigations reported no cultivatable organisms in the healthy lung [20–24]. The assumption of sterility was so firmly entrenched that the original iteration of the Human Microbiome Project (HMP) omitted the lung from its list of sampling sites [25].

  • The microbiome of the human lower airways: A next generation sequencing perspective

    2015, World Allergy Organization Journal
    Citation Excerpt :

    Culture-independent methods have enabled the detection of bacteria in some rather unexpected niches in the human body. The lower respiratory tract of healthy individuals has been considered a sterile environment where the presence of any bacteria, typically revealed by culturing, represents an abnormal, unhealthy state [4, 5]. As with many other environments, this may have been caused by the fact that the microbes present are difficult to culture under standard laboratory conditions.

View all citing articles on Scopus

Supported in Part by Grant No. RR00068-21 from the National Institutes of Health, General Clinical Research Center, University of Cincinnati.

Manuscript received November 14, 1985; revision accepted August 12.

View full text