Effect of previous antimicrobial therapy on the accuracy of the main procedures used to diagnose nosocomial pneumonia in patients who are using ventilation.
Anti-Bacterial Agents; Aged; Anti-Bacterial Agents/therapeutic use; Bacteria/drug effects; Bacteria/isolation & purification; Bronchoalveolar Lavage Fluid/cytology; Bronchoalveolar Lavage Fluid/microbiology; Bronchoscopy; Cross Infection/diagnosis; Cross Infection/microbiology; Cross Infection/therapy; Drug Resistance, Microbial; Drug Therapy, Combination/therapeutic use; Fiber Optic Technology; Humans; Middle Aged; Pneumonia, Bacterial/diagnosis; Pneumonia, Bacterial/microbiology; Pneumonia, Bacterial/therapy; Prospective Studies; Sensitivity and Specificity; Respiration, Artificial; bronchoalveolar lavage; nosocomial pneumonia; previous antibiotics; protected specimen brush; Pulmonary and Respiratory Medicine; Critical Care and Intensive Care Medicine; Cardiology and Cardiovascular Medicine
Abstract :
[en] We evaluated the effect of antibiotic treatment received before the suspicion of pneumonia on the diagnostic yield of protected specimen brush (PSB), direct examination (BAL D) and culture (BAL C) of lavage fluid on consecutive mechanically ventilated patients with suspected nosocomial pneumonia. Bronchoscopy was always performed before any treatment for suspected pneumonia. One hundred and sixty-one patients with suspected pneumonia underwent PSB and BAL before any institution or change in antibiotic therapy (AB). Sixty-five patients received AB for an earlier septic episode (ON AB group) and 96 patients did not (OFF AB group). All but two strains recovered were highly resistant to previous AB. Sensitivity and specificity of each test were not different between the ON AB and OFF AB groups as well as the percentage of complete agreement between the 3 procedures, 74 and 67% respectively. We conclude that previous AB received to treat an earlier septic episode unrelated to suspected pneumonia do not affect the diagnostic yield of PSB and BAL.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Timsit, Jean-François; Intensive Care Unit, Hôpital Saint Joseph, Paris, France
Misset, Benoît ; Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs ; Intensive Care Unit, Hopital Saint Joseph, Paris, France
Renaud, Bertrand; Intensive Care Unit, Hopital Saint Joseph, Paris, France
Goldstein, Fred W.; Intensive Care Unit, Hopital Saint Joseph, Paris, France
Carlet, Jean; Intensive Care Unit, Hopital Saint Joseph, Paris, France
Language :
English
Title :
Effect of previous antimicrobial therapy on the accuracy of the main procedures used to diagnose nosocomial pneumonia in patients who are using ventilation.
Publication date :
October 1995
Journal title :
CHEST
ISSN :
0012-3692
eISSN :
1931-3543
Publisher :
American College of Chest Physicians, United States
Chastre J Viau F Brun P Prospective evaluation of the protected specimen brush for the diagnosis of pneumonia in ventilated patients Am Rev Respir Dis 130 1984 924 929
Pham PH Brun-Buisson C Legrand P Diagnosis of nosocomial pneumonia in mechanically ventilated patients: comparison of a plugged telescoping catheter with the protected specimen brush Am Rev Respir Dis 143 1995 1055 1061
Torres A Puig De La Becasa J Xaubet A Diagnostic value of quantitative cultures of bronchoalveolar lavage and telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia Am Rev Respir Dis 140 1989 306 310
Dotson RG Pingleton SK The effect of antibiotic therapy on recovery of intracellular bacteria from bronchoalveolar lavage in suspected ventilator-associated pneumonia Chest 103 1993 541 546
Johanson WG Pierce AK Sandford JP Nosocomial respiratory infection with Gram negative bacili: the significance of colonization of the respiratory tract Ann Intern Med 77 1972 701 706
Fagon JY Chastre J Hance A Detection of nosocomial lung infection in ventilated patients: use of protected specimen brush and quantitative culture techniques in 147 patients Am Rev Respir Dis 138 1988 110 116
Legall JR Loirat Ph Alperovitch A A simplified acute physiology score for ICU patients Crit Care Med 12 1984 975 977
Torres A El-Ebiary M Padro L Validation of different techniques for the diagnosis of ventilator associated pneumonia: comparison with immediate post mortem pulmonary biopsy Am J Crit Care Med 149 1994 324 331
Montravers P Fagon JY Chastre J Follow-up protected specimen brushes to assess treatment in nosocomial pneumonia Am Rev Respir Dis 147 1993 38 44
Rello J Ausina V Ricart M Impact of previous antimicrobio therapy on the etiology and outcome of ventilator-associated pneumonia Chest 104 1993 1230 1235
