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Critical Care

, 8:R422

First Online: 14 October 2004Received: 28 April 2004Revised: 19 August 2004Accepted: 02 September 2004


IntroductionDeferred or inappropriate antibiotic treatment in ventilator-associated pneumonia VAP is associated with increased mortality, and clinical and radiological criteria are frequently employed to establish an early diagnosis. Culture results are used to confirm the clinical diagnosis and to adjust or sometimes withdraw antibiotic treatment. Tracheal aspirates have been shown to be useful for these purposes. Nonetheless, little is known about the usefulness of quantitative findings in tracheal secretions for diagnosing VAP.

MethodsTo determine the value of quantification of bacterial colonies in tracheal aspirates for diagnosing VAP, we conducted a prospective follow-up study of 106 intensive care unit patients who were under ventilatory support. In total, the findings from 219 sequential weekly evaluations for VAP were examined. Clinical and radiological parameters were recorded and evaluated by three independent experts; a diagnosis of VAP required the agreement of at least two of the three experts. At the same time, cultures of tracheal aspirates were analyzed qualitatively and quantitatively 10 colony-forming units cfu-ml and 10 cfu-ml

ResultsQuantitative cultures of tracheal aspirates 10 cfu-ml and 10 cfu-ml exhibited increased specificity 48% and 78%, respectively over qualitative cultures 23%, but decreased sensitivity 26% and 65%, respectively as compared with the qualitative findings 81%. Quantification did not improve the ability to predict a diagnosis of VAP.

ConclusionQuantitative cultures of tracheal aspirates in selected critically ill patients have decreased sensitivity when compared with qualitative results, and they should not replace the latter to confirm a clinical diagnosis of VAP or to adjust antimicrobial therapy.

Keywordsbacterial pneumonia qualitative evaluation quantitative evaluation tracheal aspirates ventilator-associated pneumonia AbbreviationsBALbronchoalveolar lavage

cfucolony-forming unit

ICUintensive care unit

PSBprotected specimen brush

VAPventilator-associated pneumonia.

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Autor: Luis FernandoAranha Camargo - Fernando Vinícius De Marco - Carmen SílviaValente Barbas - Cristiane Hoelz - Marco Auréli


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