SESSION TYPE: Respiratory Infections Posters II
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: The microbial strategy to obtain respiratory tract cultures has been well established in ventilator associated pneumonia (VAP). This study evaluates the difference between non-invasive procedure, endotrachial aspirate (ETA) and invasive procedure, bronchochial washing (BW) cultures in intensive care units (ICU) retrospectively. The mortality rate of the patients with early and late onset of VAP was also evaluated.
METHODS: The study was a retrospective review of 72 consecutive patients with clinically suspected VAP in the ICU of Gangnam Severance Hospital from January to December 2011. Among these patients, 30 were confirmed as having VAP. We collected a series of paired quantitative ETA and BW culture tests from the patients and compared the diagnostic accuracy with VAP.
RESULTS: Among a total of 30 subjects, 85% were male and 15% were female, with the mean age of 44 years. Microbial cultures were positive in 17 patients (56%) among BW; and 23 patients (76%) among ETA. There was a concordance between culture results of the two procedures in 12 (40%) cases. 2 cases yielded no growth on bacterial cultures. 5 cases of positive BW culture yielded as negative on the ETA culture. Isolated organisms from BW culture were mainly multi-resistant bacteria: Acinetobacter spp. (57%), Pseudomonas aeruginosa (27%), and Methicillin resistant Staphylococcus aureus (23%) were commonly isolated pathogens. Superinfection rate was also noted: 1 patient was infected with 3 different species of bacterium and 6 patients with two species. As far as the mortality is concerned, patients with early VAP had higher mortality rate than the patients with late VAP (58% versus 38%, respectively).
CONCLUSIONS: The concordance rate between ETA and BW cultures was low. The ETA culture yielded higher sensitivity and specificity; this may create unnecessary over-utilization of antimicrobials and the development of bacterial resistance. Unexpectedly, the diagnostic efficacy of the BW cultures in suspected VAP was lower than that of ETS. Patients with early onset of VAP had higher mortality than the patients with late onset.
CLINICAL IMPLICATIONS: An improved patient care for VAP patients in ICU
DISCLOSURE: The following authors have nothing to disclose: Sang Young Kim, Chul Min Ahn, Jung Ar Shin, Min Kwang Byun, Yoon Soo Chang, Hung Jung Kim
No Product/Research Disclosure InformationGangnam Severance Hospital, Seoul, Republic of Korea