Diagnosis of ventilator-associated pneumonia: agreement between quantitative cultures of endotracheal aspiration and plugged telescoping catheter

• Published in: Intensive care medicine Vol. 30; no. 5; pp. 853 - 858
• Main Authors: ELATROUS, Souheil, BOUKEF, Riadh, LAMIA OUANES BESBES, MARGHLI, Soudani, NOOMAN, Sami, NOUIRA, Semir, ABROUG, Fekri
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01-05-2004; Berlin Springer Nature B.V
• Subjects: Agreements; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bacteria - classification; Bacteria - isolation & purification; Biological and medical sciences; Catheterization - instrumentation; Catheters; Female; Humans; Intensive care; Intensive care medicine; Male; Medical sciences; Middle Aged; Pneumonia; Pneumonia, Bacterial - diagnosis; Pneumonia, Bacterial - etiology; Pneumonia, Bacterial - mortality; Prospective Studies; Reproducibility of Results; Respiration, Artificial - adverse effects; ROC Curve; Specimen Handling - instrumentation; Specimen Handling - methods; Ventilators; France; Lung disease; Ventilator; Pneumonia; Intensive care; Ventilator-associated pneumonia; Respiratory disease; Aspiration; Diagnostic agreement; Catheter; Endotracheal aspiration; Diagnostic procedures; Plugged telescoping catheter; Diagnosis; Resuscitation
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-004-2270-0

To evaluate the diagnostic agreement between quantitative cultures of samples obtained with endotracheal aspiration (ETA) and plugged telescoping catheter (PTC).
Prospective study.
Medical ICU.
Hundred thirty-eight episodes of suspected ventilator-associated pneumonia studied in 100 consecutive patients.
For each suspected episode of ventilator-associated pneumonia, ETA and PTC were performed consecutively. The agreement between microbiological results obtained from the two techniques was evaluated (kappa statistic test). Pneumonia was diagnosed on a positive culture result of telescoping catheter with the threshold set at 10(3) cfu/ml or more. The cut-off points evaluated for ETA ranged from 10(2 )to 10(6) cfu/ml.
Micro-organisms retrieved by aspiration and telescoping catheter were similar and bacterial counts obtained by the two procedures were well correlated ( r = 0.71 p < 0.001). There was good agreement between positive and negative ETA and PTC specimens (kappa: 0.78) with a diagnostic threshold for ETA of 10(4) cfu/ml. The sensitivity and specificity of ETA for the diagnosis of PTC-confirmed pneumonia were 92% and 85%, respectively. Kappa decreased to 0.48 when the diagnostic threshold was increased to 10(6) cfu/ml.
Quantitative cultures of ETA and PTC tallied for both micro-organisms and counts. The simpler ETA appears adequate for determining the presence of pathogenic organisms in significant concentration in the lower respiratory tract.