Influence of antibiotic therapy on the cytological diagnosis of ventilator-associated pneumonia.

Department of Medical Microbiology, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
Intensive Care Medicine (Impact Factor: 5.54). 06/2008; 34(5):865-72. DOI: 10.1007/s00134-008-1015-x
Source: PubMed

ABSTRACT To assess the influence of antibiotics on the value of various cytological parameters, and their combinations, in diagnosing ventilator-associated pneumonia (VAP).
Prospective study.
The general intensive care unit (17 beds) of the University Hospital Maastricht.
Three hundred and thirty-five episodes of clinically suspected VAP (defined by the clinical and radiological criteria previously described by Bonten et al.) in 282 patients were studied.
No additional interventions were conducted.
Bronchoalveolar lavage fluid cytology included a total cell count per millilitre, differential cell count and the percentage of infected cells (cells containing phagocytised organisms). Antibiotic therapy from 72 h prior to lavage was recorded. Areas under the curve (AUCs) of receiver operating characteristic curves were calculated for various cytological parameters and their combinations, in patients with and without antibiotic therapy. In 126 episodes (37.6%) in 106 patients, VAP was confirmed. There was no difference in AUCs between patients with and without antibiotic therapy for any parameter studied. The most prominent AUCs were (for patient groups with and without antibiotics combined): total cell count, 0.65; percentage polymorphonuclear neutrophils, 0.71; and percentage infected cells, 0.90. The combination of percentage infected cells with any other cytological parameter did not increase the AUC.
Antibiotic therapy did not influence the predictive value of the percentage infected cells in BALF in diagnosing VAP.

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    ABSTRACT: Authoritative guidelines state that the diagnosis of ventilator-associated pneumonia (VAP) can be established using either endotracheal aspirate (ETA) or bronchoalveolar lavage fluid (BALF) analysis, thereby suggesting that their results are considered to be in accordance. Therefore, results of ETA Gram stain and semi-quantitative cultures were compared to results of paired BALF analysis. Different thresholds for positivity of ETAs were assessed.

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