PURPOSE: Diagnostic strategies based on tracheal aspirates in patients with severe nursing home acquired pneumonia (NHAP) have not been previously evaluated. The objectives of the study were to investigate the diagnostic value of quantitative endotracheal aspirates (QEA) cultures using increasing interpretative cutoff points compared to bronchoalveolar lavage (BAL) and protected specimen brush (PSB) quantitative cultures in the diagnosis of severe NHAP.
METHODS: Seventy five nursing home patients requiring mechanical ventilation for suspected pneumonia were studied. Endotracheal aspiration, PSB, and BAL were performed consecutively. The diagnostic yield of QEA at thresholds raging from 103 cfu/ml to 107 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 by either 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 (EA) coincided with both BAL and PSB in 30 cases while a partial agreement was present in 14 cases yielding a sensitivity and a specificity of 90% (95% confidence interval [CI] 78% to 97%) and 77% (95% CI 56% to 91%), respectively. QEA 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 for determining the presence of pneumonia in ventilated patients admitted from nursing homes when bronchoscopic procedures are not feasible or available.
CLINICAL IMPLICATIONS: This modality may be useful as a first line technique for intubated NHAP patient with clinical suspicion of pneumonia when it is more convenient to perform prior to administration of antibiotic therapy.
DISCLOSURE: Morohunfolu Akinnusi, No Financial Disclosure Information; No Product/Research Disclosure Information