A prospective study of non-bronchoscopic bronchoalveolar lavage (nbBAL) COMPARED to protected specimen brush (PSB) in the diagnosis of nosocomial pneumonia in the ventilated ICU patient

Jeffrey O. Phillips, Michael H. Metzler, Roger E. Huckfeldt, M. E. Keller, Corrigan L McBride

Research output: Contribution to journalArticle

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Abstract

Introduction: Nosocomial pneumonia is a common infection in the intensive care unit with high morbidity/mortality. Diagnostic accuracy may be improved through the use of BAL or PSB. These techniques are costly, time consuming and require some technical expertise. A non-bronchoscopic BAL technique (BAL Cath®, Ballard Medical Products, Draper, UT) has been shown to be comparably sensitive and specific to the bronchoscopic techniques. The goal of this study was to compare the PSB to nbBAL in a prospective fashion in ICU patients on mech vent. Methods: Adult patients admitted to the surgery ICU's at the University of Missouri Hospital for more than 2 days and who were suspected of nosocomial pneumonia as diagnosed by using a CDC clinical criteriawere eligible for participation in this study. Concomitant infection was ruled out. All patients with a positive quant culture obtained by PSB (defined as >103 cfu/ml) were said to have nosocomial pneumonia. In all patients, a bronchoscopic PSB was used to obtain a specimen by accepted technique. The bronchoscope was removed and a nbBAL was performed. After advancing the inner catheter as far as possible to a wedged position, a 20 ml aliquot of non-bacteriostatic sterile saline was administered and then aspirated into a sterile specimen container using an in-line three-way stopcock. This process was repeated four additional times. Results: 35 patients underwent bronchoscopy and nbBAL for suspected nosocomial pneumonia (CDC clinical criteria). Some patients had more than one set of tests performed for recurring suspected nosocomial pneumonia. There were no significant sequellae related to either technique. Paired data were available for 51 cases of suspected nosocomial pneumonia. All patients who met CDC criteria and had a positive PSB were treated with antimicrobial agents for nosocomial pneumonia. The following table shows the sensitivity and specificity of nbBAL as compared to the standard PSB. NOSOCOMIAL PNEUMONIA by PSB Test(nbBAL) Positive Negative Positive 32 4 Negative 3 12 The sensitivity of nbBAL was 91% while the specificity was 75%. The positive precective value of nbBAL was 89% and the negative predictive value was 80%. Conclusions: In adult trauma patients who met CDC criteria for nosocomial pneumonia and had no concurrent infection, nbBAL produced similar diagnostic accuracy when compared with PSB, both with quantitative cultures (positive >103 cfu/ml).

Original languageEnglish (US)
JournalCritical care medicine
Volume27
Issue number1 SUPPL.
StatePublished - Dec 1 1999

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Bronchoalveolar Lavage
Pneumonia
Prospective Studies
Centers for Disease Control and Prevention (U.S.)
Dimercaprol
Infection
Professional Competence
Bronchoscopes
Bronchoscopy
Anti-Infective Agents
Intensive Care Units
Catheters
Morbidity
Sensitivity and Specificity
Mortality
Wounds and Injuries

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

A prospective study of non-bronchoscopic bronchoalveolar lavage (nbBAL) COMPARED to protected specimen brush (PSB) in the diagnosis of nosocomial pneumonia in the ventilated ICU patient. / Phillips, Jeffrey O.; Metzler, Michael H.; Huckfeldt, Roger E.; Keller, M. E.; McBride, Corrigan L.

In: Critical care medicine, Vol. 27, No. 1 SUPPL., 01.12.1999.

Research output: Contribution to journalArticle

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abstract = "Introduction: Nosocomial pneumonia is a common infection in the intensive care unit with high morbidity/mortality. Diagnostic accuracy may be improved through the use of BAL or PSB. These techniques are costly, time consuming and require some technical expertise. A non-bronchoscopic BAL technique (BAL Cath{\circledR}, Ballard Medical Products, Draper, UT) has been shown to be comparably sensitive and specific to the bronchoscopic techniques. The goal of this study was to compare the PSB to nbBAL in a prospective fashion in ICU patients on mech vent. Methods: Adult patients admitted to the surgery ICU's at the University of Missouri Hospital for more than 2 days and who were suspected of nosocomial pneumonia as diagnosed by using a CDC clinical criteriawere eligible for participation in this study. Concomitant infection was ruled out. All patients with a positive quant culture obtained by PSB (defined as >103 cfu/ml) were said to have nosocomial pneumonia. In all patients, a bronchoscopic PSB was used to obtain a specimen by accepted technique. The bronchoscope was removed and a nbBAL was performed. After advancing the inner catheter as far as possible to a wedged position, a 20 ml aliquot of non-bacteriostatic sterile saline was administered and then aspirated into a sterile specimen container using an in-line three-way stopcock. This process was repeated four additional times. Results: 35 patients underwent bronchoscopy and nbBAL for suspected nosocomial pneumonia (CDC clinical criteria). Some patients had more than one set of tests performed for recurring suspected nosocomial pneumonia. There were no significant sequellae related to either technique. Paired data were available for 51 cases of suspected nosocomial pneumonia. All patients who met CDC criteria and had a positive PSB were treated with antimicrobial agents for nosocomial pneumonia. The following table shows the sensitivity and specificity of nbBAL as compared to the standard PSB. NOSOCOMIAL PNEUMONIA by PSB Test(nbBAL) Positive Negative Positive 32 4 Negative 3 12 The sensitivity of nbBAL was 91{\%} while the specificity was 75{\%}. The positive precective value of nbBAL was 89{\%} and the negative predictive value was 80{\%}. Conclusions: In adult trauma patients who met CDC criteria for nosocomial pneumonia and had no concurrent infection, nbBAL produced similar diagnostic accuracy when compared with PSB, both with quantitative cultures (positive >103 cfu/ml).",
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AU - Phillips, Jeffrey O.

AU - Metzler, Michael H.

AU - Huckfeldt, Roger E.

AU - Keller, M. E.

AU - McBride, Corrigan L

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N2 - Introduction: Nosocomial pneumonia is a common infection in the intensive care unit with high morbidity/mortality. Diagnostic accuracy may be improved through the use of BAL or PSB. These techniques are costly, time consuming and require some technical expertise. A non-bronchoscopic BAL technique (BAL Cath®, Ballard Medical Products, Draper, UT) has been shown to be comparably sensitive and specific to the bronchoscopic techniques. The goal of this study was to compare the PSB to nbBAL in a prospective fashion in ICU patients on mech vent. Methods: Adult patients admitted to the surgery ICU's at the University of Missouri Hospital for more than 2 days and who were suspected of nosocomial pneumonia as diagnosed by using a CDC clinical criteriawere eligible for participation in this study. Concomitant infection was ruled out. All patients with a positive quant culture obtained by PSB (defined as >103 cfu/ml) were said to have nosocomial pneumonia. In all patients, a bronchoscopic PSB was used to obtain a specimen by accepted technique. The bronchoscope was removed and a nbBAL was performed. After advancing the inner catheter as far as possible to a wedged position, a 20 ml aliquot of non-bacteriostatic sterile saline was administered and then aspirated into a sterile specimen container using an in-line three-way stopcock. This process was repeated four additional times. Results: 35 patients underwent bronchoscopy and nbBAL for suspected nosocomial pneumonia (CDC clinical criteria). Some patients had more than one set of tests performed for recurring suspected nosocomial pneumonia. There were no significant sequellae related to either technique. Paired data were available for 51 cases of suspected nosocomial pneumonia. All patients who met CDC criteria and had a positive PSB were treated with antimicrobial agents for nosocomial pneumonia. The following table shows the sensitivity and specificity of nbBAL as compared to the standard PSB. NOSOCOMIAL PNEUMONIA by PSB Test(nbBAL) Positive Negative Positive 32 4 Negative 3 12 The sensitivity of nbBAL was 91% while the specificity was 75%. The positive precective value of nbBAL was 89% and the negative predictive value was 80%. Conclusions: In adult trauma patients who met CDC criteria for nosocomial pneumonia and had no concurrent infection, nbBAL produced similar diagnostic accuracy when compared with PSB, both with quantitative cultures (positive >103 cfu/ml).

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