[Impact of quantitative and qualitative pathogen culture on the outcome of ventilator-associated pneumonia]

Abstract

Objective: To evaluate the impact diagnostic methods with either quantitative culture (QC) or qualitative routine culture (RC) on the outcome of VAP.

Methods: A prospective, controlled clinical trial in 93 consecutive VAP episodes of 31 patients receiving mechanical ventilation was conducted. VAP episodes were randomly and crossly divided into QC (43 episodes, underwent FOB-PSB-QC) and RC group (50 episodes, underwent ETA-RC). Empirical antibiotic treatment was given according to the attending physician and modified according to the results of culture and sensitivity. The outcomes of VAP were assessed.

Results: There were no differences with regard to mortality, super-infection rate, antibiotic resistance rate and cost of antibiotics when comparing QC versus RC diagnostic methods and management based on two diagnostic strategies. Inappropriate initial empirical antibiotic treatment led to a higher mortality (17.7%) when compared with those with appropriate treatment.

Conclusion: The present study demonstrates that the outcome of VAP is probably more dependent on the adequacy of the initial antibiotic treatment than on the use of either diagnostic sampling.