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Usefulness of Quantitative Endotracheal Aspirate (QEA) Comparing With Quantitative Bronchoalveolar Lavage (QBAL) Cultures to Identify the Pathogen of Ventilator Associated Pneumonia (VAP) FREE TO VIEW

Evangelina Membriani, MD; Sergio Sarquis, MD; Ariel Sosa, MD; Carlos Vay, PhD; Angela Famiglietti, PhD; Abelardo Capdevila, MD; Celica Irrazabal, MD; Patricia Vujacich, MD; Carlos Luna, MD
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Hospital de Clinicas, Universidad de Buenos Aires, Buenos Aires, Argentina

Chest. 2013;144(4_MeetingAbstracts):385A. doi:10.1378/chest.1704765
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SESSION TITLE: ICU Infections Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: To compare the yield of QBAL cultures with the yield of QEA to detect the pathogenic microorganisms, in patients with suspected VAP.

METHODS: Secondary analysis of a data base on a cohort of mechanically ventilated patients for more than 2 days who had performed routine bi-weekly QEA surveillance cultures to analyze its value to prescribe antimicrobials for VAP. QBALs yielding ≥ 104 colony forming units (cfu)/ml and QEAs yielding ≥ 106 cfu/ml were considered positive. The result of the BALs (positive, negative and the isolated pathogens) were considered the microbiological reference for comparisons with the QEAs. Sensitivity (S), specificity (E), and positive (PPV) and negative predictive values (NPV) of QEA performed the same day, one day before or one day after the BAL in patients with a clinical diagnosis of VAP.

RESULTS: During 24 months a clinical diagnosis of VAP was made in 102 cases in which a QBAL and a QEA cultures were performed separated by no more than 24 hours. The result of the QEA culture was compared with the result of the QBAL culture in patients with clinical diagnosis of VAP. NN of the VAPs were confirmed by the QBAL. Comparing with QLBA, QEA had S=0.76; E=0.14; PPV=0.46 and VPN=0.37. S for QEA performed the same day of the QBAL was 77.8%, and for those performed one day before or after it was 75.0% (p=NS); while PPV was 53.3% for the same day and 40.0% for one day before or after (p=NS). On the other hand E was 32.3% for QEA performed the same day and 6.9% for one day before or after (p=0.0004) while NPV was 58.8% for the same day and 25.0 % for one day before or after (p=0.0004).

CONCLUSIONS: According with our results the QEA performed within the 24 hours of performing the QBAL has an acceptable sensitivity to detect the pathogens of VAP. QEA obtained up to one day after the initiation of antimicrobial therapy remained had a comparable S and PPV as obtained the day of VAP diagnosis.

CLINICAL IMPLICATIONS: QEA could be used with confidence to detect the potential pathogens of VAP, even if is performed from 24 hours before and up to 24 hours after the clinical diagnosis of VAP. If this could be confirmed in other studies it could make sense to use a QEA performed less than one day after the clinical diagnosis and initiation of therapy of VAP, to detect or rule out the possible pathogens and to eventually modify the therapy when these cultures become available.

DISCLOSURE: Carlos Luna: Consultant fee, speaker bureau, advisory committee, etc.: Pfizer, Consultant fee, speaker bureau, advisory committee, etc.: Merck Sharp & Dohne, Consultant fee, speaker bureau, advisory committee, etc.: Bayer, Consultant fee, speaker bureau, advisory committee, etc.: AstraZeneca, Consultant fee, speaker bureau, advisory committee, etc.: Trius The following authors have nothing to disclose: Evangelina Membriani, Sergio Sarquis, Ariel Sosa, Carlos Vay, Angela Famiglietti, Abelardo Capdevila, Celica Irrazabal, Patricia Vujacich

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