NDLI: Diagnostic yield of quantitative endotracheal aspirates in patients with severe nursing home-acquired pneumonia

Content Provider	Springer Nature : BioMed Central
Author	El Solh, Ali A Akinnusi, Morohunfolu E Pineda, Lilibeth A Mankowski, Corey R
Abstract	Introduction Diagnostic strategies based on tracheal aspirates in patients with severe nursing home-acquired pneumonia have not previously been evaluated. The objectives of the study were to investigate, in patients with severe nursing home-acquired pneumonia, the diagnostic value of quantitative endotracheal aspirate (QEA) cultures using increasing interpretative cutoff points, as compared with bronchoalveolar lavage (BAL) and protected specimen brush (PSB) quantitative cultures. Methods Seventy-five nursing home patients requiring mechanical ventilation for suspected pneumonia were studied. Endotracheal aspirate, PSB, and BAL samples were obtained consecutively. The diagnostic yield of QEA at thresholds raging from 103 to 107 colony-forming units (cfu)/ml was assessed by calculating sensitivities, specificities, and accuracy rates. A receiver operator characteristic curve for the series of cutoff points was constructed. Results Forty-nine patients were diagnosed with pneumonia either by BAL (≤ 104 cfu/ml) or PSB (≤ 103 cfu/ml). Diagnostic accuracy of QEA was most favorable at 104 cfu/ml. At this threshold, endotracheal aspirates coincided with both BAL and PSB in 30 cases, whereas partial agreement was observed in 14 cases. This resulted in sensitivity and specificity of 90% (95% confidence interval 78% to 97%) and 77% (95% confidence interval 56% to 91%), respectively. QEA findings correlated significantly with both PSB and BAL quantitative cultures (r = 0.71 [P < 0.001] and r = 0.77 [P < 0.001], respectively). Conclusion QEA may be used as a diagnostic tool to determine the presence of pneumonia in ventilated patients admitted from nursing homes when bronchoscopic procedures are not feasible or available.
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/cc5917.pdf
Ending Page	6
Page Count	6
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/cc5917
Journal	Critical Care
Issue Number	3
Volume Number	11
Language	English
Publisher	BioMed Central
Publisher Date	2007-05-17
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine Nursing Home Resident Tracheal Aspirate Nursing Home Patient Quantitative Culture Endotracheal Aspirate
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

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