Using bronchoalveolar lavage to distinguish nosocomial pneumonia from systemic inflammatory response syndrome: A prospective analysis

Martin Croce, Timothy Fabian, M. J. Schurr, R. Boscarino, F. E. Pritchard, G. Minard, J. H. Patton, K. A. Kudsk, G. Rozycki, P. Barie, A. Borzotta

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Abstract

Objective: Ventilator-associated pneumonia (PN) is difficult to distinguish from trauma-induced systemic inflammatory response syndrome (SIRS), especially in patients with multiple injuries. Previous work using bronchoscopy and quantitative cultures demonstrated significant bacterial growth in about one-third of patients with clinical evidence of PN. In this prospective study, antibiotic therapy for PN was based solely on quantitative bronchoalveolar lavage (BAL) cultures. Methods: Mechanically ventilated trauma patients underwent bronchoscopy with BAL when they developed clinical evidence of PN: fever (temperature > 100.5°F), white blood cells > 10,000 or >10% immature forms, purulent sputum, and new or changing infiltrate on chest roentgenogram. Patients with other infections or those receiving antibiotics for any other reason were excluded. Empiric antibiotic therapy for PN was started at the time of BAL. If the quantitative cultures revealed ≥105 colony-forming units (CFU)/mL, that patient was defined as having PN and was treated. If the cultures revealed <105 CFU/mL, that patient was defined as having SIRS, and empiric therapy was stopped. Results: Forty-three patients (88% blunt, 12% penetrating) underwent bronchoscopy with BAL 55 times. Mean age was 40 and Injury Severity Score was 25. Twenty patients had ≥105 CFU/mL (47%) and 23 had <105 CFU/mL (53%). There were no differences in age, Injury Severity Score, temperature, white blood cell count, or ventilator days before BAL between groups. Sixty-five percent of those with SIRS improved after empiric therapy was stopped (average 3.3 days), and 35% underwent repeat BAL. Three patients with the initial diagnosis of SIRS developed PN (13% of SIRS). Mortality for PN was 15%, compared with 17% for SIRS; no deaths were related to antibiotic therapy. Conclusions: SIRS, which can mimic PN, is common in trauma patients. These entities can he distinguished by bronchoscopy with BAL. Basing antibiotic therapy solely on quantitative BAL cultures is efficacious in trauma patients.

Original languageEnglish (US)
Pages (from-to)1134-1140
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume39
Issue number6
DOIs
StatePublished - Dec 1 1995

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Systemic Inflammatory Response Syndrome
Bronchoalveolar Lavage
Pneumonia
Bronchoscopy
Anti-Bacterial Agents
Stem Cells
Injury Severity Score
Wounds and Injuries
Therapeutics
Ventilator-Associated Pneumonia
Temperature
Multiple Trauma
Mechanical Ventilators
Sputum
Leukocyte Count
Leukocytes
Fever
Thorax
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Using bronchoalveolar lavage to distinguish nosocomial pneumonia from systemic inflammatory response syndrome : A prospective analysis. / Croce, Martin; Fabian, Timothy; Schurr, M. J.; Boscarino, R.; Pritchard, F. E.; Minard, G.; Patton, J. H.; Kudsk, K. A.; Rozycki, G.; Barie, P.; Borzotta, A.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 39, No. 6, 01.12.1995, p. 1134-1140.

Research output: Contribution to journalArticle

Croce, M, Fabian, T, Schurr, MJ, Boscarino, R, Pritchard, FE, Minard, G, Patton, JH, Kudsk, KA, Rozycki, G, Barie, P & Borzotta, A 1995, 'Using bronchoalveolar lavage to distinguish nosocomial pneumonia from systemic inflammatory response syndrome: A prospective analysis', Journal of Trauma - Injury, Infection and Critical Care, vol. 39, no. 6, pp. 1134-1140. https://doi.org/10.1097/00005373-199512000-00022
Croce, Martin ; Fabian, Timothy ; Schurr, M. J. ; Boscarino, R. ; Pritchard, F. E. ; Minard, G. ; Patton, J. H. ; Kudsk, K. A. ; Rozycki, G. ; Barie, P. ; Borzotta, A. / Using bronchoalveolar lavage to distinguish nosocomial pneumonia from systemic inflammatory response syndrome : A prospective analysis. In: Journal of Trauma - Injury, Infection and Critical Care. 1995 ; Vol. 39, No. 6. pp. 1134-1140.
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title = "Using bronchoalveolar lavage to distinguish nosocomial pneumonia from systemic inflammatory response syndrome: A prospective analysis",
abstract = "Objective: Ventilator-associated pneumonia (PN) is difficult to distinguish from trauma-induced systemic inflammatory response syndrome (SIRS), especially in patients with multiple injuries. Previous work using bronchoscopy and quantitative cultures demonstrated significant bacterial growth in about one-third of patients with clinical evidence of PN. In this prospective study, antibiotic therapy for PN was based solely on quantitative bronchoalveolar lavage (BAL) cultures. Methods: Mechanically ventilated trauma patients underwent bronchoscopy with BAL when they developed clinical evidence of PN: fever (temperature > 100.5°F), white blood cells > 10,000 or >10{\%} immature forms, purulent sputum, and new or changing infiltrate on chest roentgenogram. Patients with other infections or those receiving antibiotics for any other reason were excluded. Empiric antibiotic therapy for PN was started at the time of BAL. If the quantitative cultures revealed ≥105 colony-forming units (CFU)/mL, that patient was defined as having PN and was treated. If the cultures revealed <105 CFU/mL, that patient was defined as having SIRS, and empiric therapy was stopped. Results: Forty-three patients (88{\%} blunt, 12{\%} penetrating) underwent bronchoscopy with BAL 55 times. Mean age was 40 and Injury Severity Score was 25. Twenty patients had ≥105 CFU/mL (47{\%}) and 23 had <105 CFU/mL (53{\%}). There were no differences in age, Injury Severity Score, temperature, white blood cell count, or ventilator days before BAL between groups. Sixty-five percent of those with SIRS improved after empiric therapy was stopped (average 3.3 days), and 35{\%} underwent repeat BAL. Three patients with the initial diagnosis of SIRS developed PN (13{\%} of SIRS). Mortality for PN was 15{\%}, compared with 17{\%} for SIRS; no deaths were related to antibiotic therapy. Conclusions: SIRS, which can mimic PN, is common in trauma patients. These entities can he distinguished by bronchoscopy with BAL. Basing antibiotic therapy solely on quantitative BAL cultures is efficacious in trauma patients.",
author = "Martin Croce and Timothy Fabian and Schurr, {M. J.} and R. Boscarino and Pritchard, {F. E.} and G. Minard and Patton, {J. H.} and Kudsk, {K. A.} and G. Rozycki and P. Barie and A. Borzotta",
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T1 - Using bronchoalveolar lavage to distinguish nosocomial pneumonia from systemic inflammatory response syndrome

T2 - A prospective analysis

AU - Croce, Martin

AU - Fabian, Timothy

AU - Schurr, M. J.

AU - Boscarino, R.

AU - Pritchard, F. E.

AU - Minard, G.

AU - Patton, J. H.

AU - Kudsk, K. A.

AU - Rozycki, G.

AU - Barie, P.

AU - Borzotta, A.

PY - 1995/12/1

Y1 - 1995/12/1

N2 - Objective: Ventilator-associated pneumonia (PN) is difficult to distinguish from trauma-induced systemic inflammatory response syndrome (SIRS), especially in patients with multiple injuries. Previous work using bronchoscopy and quantitative cultures demonstrated significant bacterial growth in about one-third of patients with clinical evidence of PN. In this prospective study, antibiotic therapy for PN was based solely on quantitative bronchoalveolar lavage (BAL) cultures. Methods: Mechanically ventilated trauma patients underwent bronchoscopy with BAL when they developed clinical evidence of PN: fever (temperature > 100.5°F), white blood cells > 10,000 or >10% immature forms, purulent sputum, and new or changing infiltrate on chest roentgenogram. Patients with other infections or those receiving antibiotics for any other reason were excluded. Empiric antibiotic therapy for PN was started at the time of BAL. If the quantitative cultures revealed ≥105 colony-forming units (CFU)/mL, that patient was defined as having PN and was treated. If the cultures revealed <105 CFU/mL, that patient was defined as having SIRS, and empiric therapy was stopped. Results: Forty-three patients (88% blunt, 12% penetrating) underwent bronchoscopy with BAL 55 times. Mean age was 40 and Injury Severity Score was 25. Twenty patients had ≥105 CFU/mL (47%) and 23 had <105 CFU/mL (53%). There were no differences in age, Injury Severity Score, temperature, white blood cell count, or ventilator days before BAL between groups. Sixty-five percent of those with SIRS improved after empiric therapy was stopped (average 3.3 days), and 35% underwent repeat BAL. Three patients with the initial diagnosis of SIRS developed PN (13% of SIRS). Mortality for PN was 15%, compared with 17% for SIRS; no deaths were related to antibiotic therapy. Conclusions: SIRS, which can mimic PN, is common in trauma patients. These entities can he distinguished by bronchoscopy with BAL. Basing antibiotic therapy solely on quantitative BAL cultures is efficacious in trauma patients.

AB - Objective: Ventilator-associated pneumonia (PN) is difficult to distinguish from trauma-induced systemic inflammatory response syndrome (SIRS), especially in patients with multiple injuries. Previous work using bronchoscopy and quantitative cultures demonstrated significant bacterial growth in about one-third of patients with clinical evidence of PN. In this prospective study, antibiotic therapy for PN was based solely on quantitative bronchoalveolar lavage (BAL) cultures. Methods: Mechanically ventilated trauma patients underwent bronchoscopy with BAL when they developed clinical evidence of PN: fever (temperature > 100.5°F), white blood cells > 10,000 or >10% immature forms, purulent sputum, and new or changing infiltrate on chest roentgenogram. Patients with other infections or those receiving antibiotics for any other reason were excluded. Empiric antibiotic therapy for PN was started at the time of BAL. If the quantitative cultures revealed ≥105 colony-forming units (CFU)/mL, that patient was defined as having PN and was treated. If the cultures revealed <105 CFU/mL, that patient was defined as having SIRS, and empiric therapy was stopped. Results: Forty-three patients (88% blunt, 12% penetrating) underwent bronchoscopy with BAL 55 times. Mean age was 40 and Injury Severity Score was 25. Twenty patients had ≥105 CFU/mL (47%) and 23 had <105 CFU/mL (53%). There were no differences in age, Injury Severity Score, temperature, white blood cell count, or ventilator days before BAL between groups. Sixty-five percent of those with SIRS improved after empiric therapy was stopped (average 3.3 days), and 35% underwent repeat BAL. Three patients with the initial diagnosis of SIRS developed PN (13% of SIRS). Mortality for PN was 15%, compared with 17% for SIRS; no deaths were related to antibiotic therapy. Conclusions: SIRS, which can mimic PN, is common in trauma patients. These entities can he distinguished by bronchoscopy with BAL. Basing antibiotic therapy solely on quantitative BAL cultures is efficacious in trauma patients.

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