BACKGROUND: Bronchoalveolar lavage (BAL) is recommended to facilitate the diagnosis of ventilator-associated pneumonia (VAP). It is unclear if bilateral sampling improves the accuracy of BAL. METHODS: Consecutive patients with clinical suspicion for VAP were analyzed. All patients underwent bilateral BAL. A threshold of >10(4) colony-forming units (cfu)/mL was diagnostic for VAP (VAP positive). Samples were concordant if the organism(s) and thresholds from both lungs were diagnostically consistent. Organisms </=10(4) cfu/mL with growth on the contralateral sample >10(4) cfu/mL were considered false-negative samples. RESULTS: Between November 2005 and April 2006, 73 patients were considered clinically suspicious for VAP. Forty-four (60%) patients were VAP positive. Twenty-eight (64%) VAP patients had concordant samples. Overall, there were 15 false-negative samples. Sole use of the unilateral samples to guide treatment would have inappropriately directed antibiotic avoidance and/or discontinuation in 25% of VAP patients. Influence of the chest radiograph was equivocal because of the presence of bilateral infiltrates in 80% of discordant samples. CONCLUSIONS: Bilateral BAL improves the accuracy of bronchoscopy in diagnosing VAP. Unilateral BAL may be insensitive in patients with clinically significant contralateral infection.
BACKGROUND: Bronchoalveolar lavage (BAL) is recommended to facilitate the diagnosis of ventilator-associated pneumonia (VAP). It is unclear if bilateral sampling improves the accuracy of BAL. METHODS: Consecutive patients with clinical suspicion for VAP were analyzed. All patients underwent bilateral BAL. A threshold of >10(4) colony-forming units (cfu)/mL was diagnostic for VAP (VAP positive). Samples were concordant if the organism(s) and thresholds from both lungs were diagnostically consistent. Organisms </=10(4) cfu/mL with growth on the contralateral sample >10(4) cfu/mL were considered false-negative samples. RESULTS: Between November 2005 and April 2006, 73 patients were considered clinically suspicious for VAP. Forty-four (60%) patients were VAP positive. Twenty-eight (64%) VAP patients had concordant samples. Overall, there were 15 false-negative samples. Sole use of the unilateral samples to guide treatment would have inappropriately directed antibiotic avoidance and/or discontinuation in 25% of VAP patients. Influence of the chest radiograph was equivocal because of the presence of bilateral infiltrates in 80% of discordant samples. CONCLUSIONS: Bilateral BAL improves the accuracy of bronchoscopy in diagnosing VAP. Unilateral BAL may be insensitive in patients with clinically significant contralateral infection.
Authors: Mark A Jonker; Tina M Sauerhammer; Lee D Faucher; Michael J Schurr; Kenneth A Kudsk Journal: Surg Infect (Larchmt) Date: 2012-12-16 Impact factor: 2.150
Authors: Basem Al-Omari; Peter McMeekin; A Joy Allen; Ahsan R Akram; Sara Graziadio; Jana Suklan; William S Jones; B Clare Lendrem; Amanda Winter; Milo Cullinan; Joanne Gray; Kevin Dhaliwal; Timothy S Walsh; Thomas H Craven Journal: BMC Pulm Med Date: 2021-06-09 Impact factor: 3.317