Protected specimen brush or bronchoalveolar lavage to diagnose bacterial nosocomial pneumonia in ventilated adults: A meta-analysis

Protected specimen brush or bronchoalveolar lavage to diagnose bacterial nosocomial pneumonia in ventilated adults: A meta-analysis

OBJECTIVE:We conducted a meta-analysis by using summary receiver operating characteristic curves to compare the diagnostic value for bacterial nosocomial pneumonia of the followinga) quantitative culture (colony-forming units per milliliter or CFU/mL) of respiratory secretions collected with a bronc...

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Bibliographic Details
Published in:Critical care medicine Vol. 27; no. 11; pp. 2548 - 2560
Main Authors: de Jaeger, Annik, Litalien, Catherine, Lacroix, Jacques, Guertin, Marie-Claude, Infante-Rivard, Claire
Format: Journal Article
Language:English
Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-11-1999
Lippincott
Subjects:
Adult
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anti-Bacterial Agents - therapeutic use
Bacteria - isolation & purification
Biological and medical sciences
Bronchoalveolar Lavage - standards
Bronchoalveolar Lavage Fluid - cytology
Bronchoalveolar Lavage Fluid - microbiology
Cross Infection - diagnosis
Cross Infection - drug therapy
Emergency and intensive respiratory care
Humans
Intensive care medicine
Intensive Care Units
Lung - microbiology
Lung - pathology
Medical sciences
Middle Aged
Mucus - cytology
Mucus - microbiology
Pneumonia, Bacterial - diagnosis
Pneumonia, Bacterial - drug therapy
Prospective Studies
Reproducibility of Results
Respiration, Artificial
ROC Curve
Specimen Handling - instrumentation
Specimen Handling - standards
Surveys and Questionnaires
Human
Bronchoscopy
Nosocomial infection
Lung disease
Intensive care
Pneumonia
Respiratory disease
Cytologic investigation
Brushing
Artificial ventilation
Bacteriological investigation
Metaanalysis
Infection
Microbiological investigation
Bronchoalveolar lavage
Bacteriosis
Predictive value
Adult
Complication
Endoscopy
Diagnosis
Technique
Mechanical ventilation
Comparative study
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Summary:OBJECTIVE:We conducted a meta-analysis by using summary receiver operating characteristic curves to compare the diagnostic value for bacterial nosocomial pneumonia of the followinga) quantitative culture (colony-forming units per milliliter or CFU/mL) of respiratory secretions collected with a bronchoscopic protected specimen brush (PSB); b) quantitative culture of a bronchoscopic bronchoalveolar lavage (BAL); and c) the percentage of infected cells (IC) in BAL. DATA SOURCES:All studies published in the English or the French language, through January 1, 1995, on the evaluation of PSB or BAL for the diagnosis of pneumonia were considered for analysis. The relevant literature was identified through computer and reference searching and by experts in the field. STUDY SELECTION:A study was included if at least two of three independent readers regarded its purpose as the evaluation of CFU-PSB, CFU-BAL, or IC-BAL for the diagnosis in human beings of bacterial nosocomial pneumonia in ventilated adults and if the study was prospective and published in a peer-reviewed journal. DATA EXTRACTION:Three readers reviewed all published articles and decided whether to include each study; consensus was defined as agreement by at least two readers. The authors of each original article included in the meta-analysis were asked to complete a questionnaire in which they were asked to check and to correct the data extracted by one of the independent readers. DATA SYNTHESIS:Summary receiver operating characteristic curves were used to compare the efficacy of three diagnostic tests. Eighteen studies on CFU-PSB (795 patients) were included, as well as 11 studies on CFU-BAL (435 patients) and 11 on IC-BAL (766 patients). The accuracy of these tests was not different. However, it seems that administration of previous antibiotics markedly decreased accuracy of CFU-PSB (p = .0002) but not the accuracy of CFU-BAL and that of IC-BAL. CONCLUSION:Both PSB and BAL are reliable to diagnose bacterial nosocomial pneumonia. Because CFU-BAL and IC-BAL seemed more resistant to the effects of antibiotics, we recommend BAL rather than PSB if the patient is already receiving antibiotics.
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-1
content type line 23
ISSN:0090-3493
1530-0293
DOI:10.1097/00003246-199911000-00037