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Comparative Study
. 2014 Oct;52(10):3597-604.
doi: 10.1128/JCM.01494-14. Epub 2014 Jul 30.

Endotracheal aspirate and bronchoalveolar lavage fluid analysis: interchangeable diagnostic modalities in suspected ventilator-associated pneumonia?

Johannes B J Scholte  1 , Helke A van Dessel  2 , Catharina F M Linssen  3 , Dennis C J J Bergmans  4 , Paul H M Savelkoul  2 , Paul M H J Roekaerts  4 , Walther N K A van Mook  4
Affiliations
Comparative Study

Endotracheal aspirate and bronchoalveolar lavage fluid analysis: interchangeable diagnostic modalities in suspected ventilator-associated pneumonia?

Johannes B J Scholte et al. J Clin Microbiol. 2014 Oct.

Abstract

Authoritative guidelines state that the diagnosis of ventilator-associated pneumonia (VAP) can be established using either endotracheal aspirate (ETA) or bronchoalveolar lavage fluid (BALF) analysis, thereby suggesting that their results are considered to be in accordance. Therefore, the results of ETA Gram staining and semiquantitative cultures were compared to the results from a paired ETA-BALF analysis. Different thresholds for the positivity of ETAs were assessed. This was a prospective study of all patients who underwent bronchoalveolar lavage for suspected VAP in a 27-bed university intensive care unit during an 8-year period. VAP was diagnosed when ≥ 2% of the BALF cells contained intracellular organisms and/or when BALF quantitative culture revealed ≥ 10(4) CFU/ml of potentially pathogenic microorganisms. ETA Gram staining and semiquantitative cultures were compared to the results from paired BALF analysis by Cohen's kappa coefficients. VAP was suspected in 311 patients and diagnosed in 122 (39%) patients. In 288 (93%) patients, the results from the ETA analysis were available for comparison. Depending on the threshold used and the diagnostic modality, VAP incidences varied from 15% to 68%. For the diagnosis of VAP, the most accurate threshold for positivity of ETA semiquantitative cultures was moderate or heavy growth, whereas the optimal threshold for BALF Gram staining was ≥ 1 microorganisms per high power field. The Cohen's kappa coefficients were 0.22, 0.31, and 0.60 for ETA and paired BALF Gram stains, cultures, and BALF Gram stains, respectively. Since the ETA and BALF Gram stains and cultures agreed only fairly, they are probably not interchangeable for diagnosing VAP.

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Figures

FIG 1
FIG 1
Flow chart, including patient characteristics and incidences of ventilator-associated pneumonia (VAP) using different diagnostic thresholds. BAL, bronchoalveolar lavage; ETA, endotracheal aspirate; ICO, intracellular organisms; SD, standard deviation.
FIG 2
FIG 2
Receiver operating characteristic curve of endotracheal aspirate semiquantitative cultures according to different thresholds for positivity.
See this image and copyright information in PMC

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