BACKGROUND: The presence of intracellular organisms (ICOs) in polymorphonuclear cells obtained from respiratory secretions is a possible method for rapid diagnosis of ventilator-associated pneumonia. We correlated ICOs with quantitative endotracheal aspirate (QA) in intubated patients. METHODS: Consecutive intubated patients in the surgical intensive care unit had respiratory samples obtained every 2 days until extubation. Two thresholds for ICOs and quantitative culture were examined. Sensitivity, specificity, and positive and negative predictive values were calculated using QA as reference. RESULTS: One hundred one samples were obtained from 35 patients. Colony counts >or= 100,000 were found in 34 samples; 60 samples had colony counts >or= 10,000. Antibiotic use did not affect the sensitivity or specificity of ICOs. Sensitivity of ICOs was 39% to 85%, and specificity was 82% to 97%. Positive predictive value was 70% to 96%, and negative predictive value was 50% to 91%. CONCLUSION: ICOs provide a quick method for establishing the presence of a significant bacterial load in the respiratory tract. Accuracy of ICOs in predicting a positive QA is not affected by concurrent antibiotics.
BACKGROUND: The presence of intracellular organisms (ICOs) in polymorphonuclear cells obtained from respiratory secretions is a possible method for rapid diagnosis of ventilator-associated pneumonia. We correlated ICOs with quantitative endotracheal aspirate (QA) in intubated patients. METHODS: Consecutive intubated patients in the surgical intensive care unit had respiratory samples obtained every 2 days until extubation. Two thresholds for ICOs and quantitative culture were examined. Sensitivity, specificity, and positive and negative predictive values were calculated using QA as reference. RESULTS: One hundred one samples were obtained from 35 patients. Colony counts >or= 100,000 were found in 34 samples; 60 samples had colony counts >or= 10,000. Antibiotic use did not affect the sensitivity or specificity of ICOs. Sensitivity of ICOs was 39% to 85%, and specificity was 82% to 97%. Positive predictive value was 70% to 96%, and negative predictive value was 50% to 91%. CONCLUSION: ICOs provide a quick method for establishing the presence of a significant bacterial load in the respiratory tract. Accuracy of ICOs in predicting a positive QA is not affected by concurrent antibiotics.
Authors: R G Masterton; A Galloway; G French; M Street; J Armstrong; E Brown; J Cleverley; P Dilworth; C Fry; A D Gascoigne; Alan Knox; Dilip Nathwani; Robert Spencer; Mark Wilcox Journal: J Antimicrob Chemother Date: 2008-04-29 Impact factor: 5.790
Authors: Alvaro Rea-Neto; Nazah Cherif M Youssef; Fabio Tuche; Frank Brunkhorst; V Marco Ranieri; Konrad Reinhart; Yasser Sakr Journal: Crit Care Date: 2008-04-21 Impact factor: 9.097