Utility of preliminary bronchoalveolar lavage results in suspected ventilator-associated pneumonia

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

BACKGROUND:: More than one half of lower respiratory cultures are negative for ventilator-associated pneumonia (VAP) and final reporting requires 72 hours to 96 hours. A previous retrospective study concluded that preliminary bronchoalveolar lavage (BAL) culture results (pBAL), reported at approximately 24 hours, accurately predicted final BAL culture results (fBAL). Our objective was to verify the predictive value of pBALs for fBALs, and evaluate the use of insignificant (1-99,999 cfu/mL) pBALs for rapid discontinuation of empirical antibiotics. METHODS:: All BALs performed in the intensive care unit (ICU) of the Presley Regional Trauma Center were used to compare pBALs with fBALs. Trauma intensive care unit patients whose antibiotics were discontinued using pBALs (study group), were compared with a historical control group who had their antibiotics discontinued using fBALs. RESULTS:: Preliminary and final results of 474 prospectively collected BALs were compared. Significant pBALs had a positive predictive value of 100%, whereas the negative predictive values of "no growth to date" and insignificant pBALs were 99% and 95%, respectively. Study patients (n ≤ 176) were similar to control patients (n ≤ 112) except for a higher median injury severity score (34 vs. 29; p < 0.001). The median (interquartile range) duration of empirical antibiotic therapy in patients without VAP was shorter for study patients [1.5 (1.25, 2) vs. 3 (3, 4) days, p < 0.001]. Empirical antibiotics were temporarily interrupted in four patients with VAP because of falsely negative pBALs without adverse clinical sequelae. CONCLUSIONS:: Preliminary BALs were highly predictive for final results. Using insignificant pBALs appears to be a safe strategy for promptly discontinuing empirical antibiotics in trauma patients with suspected VAP.

Original languageEnglish (US)
Pages (from-to)1271-1277
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume65
Issue number6
DOIs
StatePublished - Dec 1 2008

Fingerprint

Ventilator-Associated Pneumonia
Bronchoalveolar Lavage
Anti-Bacterial Agents
Dimercaprol
Intensive Care Units
Injury Severity Score
Trauma Centers
Wounds and Injuries
Retrospective Studies
Control Groups
Growth

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

@article{835027038f0b415d8114e7969cfdc848,
title = "Utility of preliminary bronchoalveolar lavage results in suspected ventilator-associated pneumonia",
abstract = "BACKGROUND:: More than one half of lower respiratory cultures are negative for ventilator-associated pneumonia (VAP) and final reporting requires 72 hours to 96 hours. A previous retrospective study concluded that preliminary bronchoalveolar lavage (BAL) culture results (pBAL), reported at approximately 24 hours, accurately predicted final BAL culture results (fBAL). Our objective was to verify the predictive value of pBALs for fBALs, and evaluate the use of insignificant (1-99,999 cfu/mL) pBALs for rapid discontinuation of empirical antibiotics. METHODS:: All BALs performed in the intensive care unit (ICU) of the Presley Regional Trauma Center were used to compare pBALs with fBALs. Trauma intensive care unit patients whose antibiotics were discontinued using pBALs (study group), were compared with a historical control group who had their antibiotics discontinued using fBALs. RESULTS:: Preliminary and final results of 474 prospectively collected BALs were compared. Significant pBALs had a positive predictive value of 100{\%}, whereas the negative predictive values of {"}no growth to date{"} and insignificant pBALs were 99{\%} and 95{\%}, respectively. Study patients (n ≤ 176) were similar to control patients (n ≤ 112) except for a higher median injury severity score (34 vs. 29; p < 0.001). The median (interquartile range) duration of empirical antibiotic therapy in patients without VAP was shorter for study patients [1.5 (1.25, 2) vs. 3 (3, 4) days, p < 0.001]. Empirical antibiotics were temporarily interrupted in four patients with VAP because of falsely negative pBALs without adverse clinical sequelae. CONCLUSIONS:: Preliminary BALs were highly predictive for final results. Using insignificant pBALs appears to be a safe strategy for promptly discontinuing empirical antibiotics in trauma patients with suspected VAP.",
author = "Joseph Swanson and Wood, {G Christopher} and Martin Croce and Mueller, {Eric W.} and Bradley Boucher and Timothy Fabian",
year = "2008",
month = "12",
day = "1",
doi = "10.1097/TA.0b013e3181574d6a",
language = "English (US)",
volume = "65",
pages = "1271--1277",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Utility of preliminary bronchoalveolar lavage results in suspected ventilator-associated pneumonia

AU - Swanson, Joseph

AU - Wood, G Christopher

AU - Croce, Martin

AU - Mueller, Eric W.

AU - Boucher, Bradley

AU - Fabian, Timothy

PY - 2008/12/1

Y1 - 2008/12/1

N2 - BACKGROUND:: More than one half of lower respiratory cultures are negative for ventilator-associated pneumonia (VAP) and final reporting requires 72 hours to 96 hours. A previous retrospective study concluded that preliminary bronchoalveolar lavage (BAL) culture results (pBAL), reported at approximately 24 hours, accurately predicted final BAL culture results (fBAL). Our objective was to verify the predictive value of pBALs for fBALs, and evaluate the use of insignificant (1-99,999 cfu/mL) pBALs for rapid discontinuation of empirical antibiotics. METHODS:: All BALs performed in the intensive care unit (ICU) of the Presley Regional Trauma Center were used to compare pBALs with fBALs. Trauma intensive care unit patients whose antibiotics were discontinued using pBALs (study group), were compared with a historical control group who had their antibiotics discontinued using fBALs. RESULTS:: Preliminary and final results of 474 prospectively collected BALs were compared. Significant pBALs had a positive predictive value of 100%, whereas the negative predictive values of "no growth to date" and insignificant pBALs were 99% and 95%, respectively. Study patients (n ≤ 176) were similar to control patients (n ≤ 112) except for a higher median injury severity score (34 vs. 29; p < 0.001). The median (interquartile range) duration of empirical antibiotic therapy in patients without VAP was shorter for study patients [1.5 (1.25, 2) vs. 3 (3, 4) days, p < 0.001]. Empirical antibiotics were temporarily interrupted in four patients with VAP because of falsely negative pBALs without adverse clinical sequelae. CONCLUSIONS:: Preliminary BALs were highly predictive for final results. Using insignificant pBALs appears to be a safe strategy for promptly discontinuing empirical antibiotics in trauma patients with suspected VAP.

AB - BACKGROUND:: More than one half of lower respiratory cultures are negative for ventilator-associated pneumonia (VAP) and final reporting requires 72 hours to 96 hours. A previous retrospective study concluded that preliminary bronchoalveolar lavage (BAL) culture results (pBAL), reported at approximately 24 hours, accurately predicted final BAL culture results (fBAL). Our objective was to verify the predictive value of pBALs for fBALs, and evaluate the use of insignificant (1-99,999 cfu/mL) pBALs for rapid discontinuation of empirical antibiotics. METHODS:: All BALs performed in the intensive care unit (ICU) of the Presley Regional Trauma Center were used to compare pBALs with fBALs. Trauma intensive care unit patients whose antibiotics were discontinued using pBALs (study group), were compared with a historical control group who had their antibiotics discontinued using fBALs. RESULTS:: Preliminary and final results of 474 prospectively collected BALs were compared. Significant pBALs had a positive predictive value of 100%, whereas the negative predictive values of "no growth to date" and insignificant pBALs were 99% and 95%, respectively. Study patients (n ≤ 176) were similar to control patients (n ≤ 112) except for a higher median injury severity score (34 vs. 29; p < 0.001). The median (interquartile range) duration of empirical antibiotic therapy in patients without VAP was shorter for study patients [1.5 (1.25, 2) vs. 3 (3, 4) days, p < 0.001]. Empirical antibiotics were temporarily interrupted in four patients with VAP because of falsely negative pBALs without adverse clinical sequelae. CONCLUSIONS:: Preliminary BALs were highly predictive for final results. Using insignificant pBALs appears to be a safe strategy for promptly discontinuing empirical antibiotics in trauma patients with suspected VAP.

UR - http://www.scopus.com/inward/record.url?scp=67650576613&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67650576613&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e3181574d6a

DO - 10.1097/TA.0b013e3181574d6a

M3 - Article

C2 - 19077612

AN - SCOPUS:67650576613

VL - 65

SP - 1271

EP - 1277

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 6

ER -