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The Standardization of Criteria for Processing and Interpreting Laboratory Specimens in Patients With Suspected Ventilator-Associated Pneumonia

Published online by Cambridge University Press:  21 June 2016

Vickie S. Baselski ,
Mahmoud El-Torky ,
Jacqueline J. Coalson  and
John P. Griffin
Vickie S. Baselski*
Affiliation:
Departments of Pathology and Microbiology, The University of Tennessee, Memphis Department of Pathology, University of Texas Health Science Center at San Antonio Division of Pulmonary and Critical Care Medicine, The University of Tennessee, Memphis
Mahmoud El-Torky
Affiliation:
Departments of Pathology and Microbiology, The University of Tennessee, Memphis Department of Pathology, University of Texas Health Science Center at San Antonio Division of Pulmonary and Critical Care Medicine, The University of Tennessee, Memphis
Jacqueline J. Coalson
Affiliation:
Departments of Pathology and Microbiology, The University of Tennessee, Memphis Department of Pathology, University of Texas Health Science Center at San Antonio Division of Pulmonary and Critical Care Medicine, The University of Tennessee, Memphis
John P. Griffin
Affiliation:
Departments of Pathology and Microbiology, The University of Tennessee, Memphis Department of Pathology, University of Texas Health Science Center at San Antonio Division of Pulmonary and Critical Care Medicine, The University of Tennessee, Memphis
*
Rm 568M, Department of Pathology, University of Tennessee, 399 Madison Ave., Memphis, TN 38163
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Extract

The microbiologic analysis of respiratory specimens is a key component of both the clinical investigation of ventilator-associated pneumonia (VAP) and patient care. Although there is a substantial body of literature on the use of a variety of lower respiratory tract specimens, there is little standardization of the approaches to processing and interpreting results from the various specimens. The purpose of this communication is to delineate specific recommendations for the microbiologic analysis of specimens originating from the lower respiratory tract, as developed by the Laboratory Analysis Group of the Consensus Conference.

Type
Proceedings of the First International Consensus Conference on the Clinical Investigation of Ventilator-Associated Pneumonia
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 11 , November 1992 , pp. 657 - 666
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

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References

1. Hill, JD, Ratliff, JL, Parrott, JCW, et al. Pulmonary pathology in acute respiratory insufficiency: lung biopsy as a diagnostic tool. J Thorac Cardiovasc Surg. 1976;71:64–70.Google Scholar
2. Berger, R Arango, L. Etiologic diagnosis of bacterial nosocomial pneumonia in seriously ill patients. Crit Care Med. 1985;13:833–836.Google Scholar
3. Villers, D, Derriennic, M, Raffi, F, et al. Reliability of the bronchoscopic protected catheter brush in intubated and ventilated patients. Chest. 1985;88:527–530.Google Scholar
4. Baughman, RP, Thorpe, JE, Staneck, J, et al. Use of the protected specimen brush in patients with endotracheal or tracheostomy tubes. Chest. 1987;91:233–236.Google Scholar
5. Lambert, RS, Vereen, LE George, RB. Comparison of tracheal aspirates and protected brush catheter specimens for identifying pathogenic bacteria in mechanically ventilated patients. Am J Med Sci. 1989;297:377–382.Google Scholar
6. Salata, RA, Lederman, MM, Shlaes, DM, et al. Diagnosis of nosocomial pneumonia in intubated, intensive care unit patients. Am Rev Respir Dis. 1987;135:426–432.Google Scholar
7. Torres, A, de la Bellacasa, JP, Rodriquez-Roisin, R, et al. Diagnostic value of telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia using the Metras catheter. Am Rev Respir Dis. 1988;138:117–120.Google Scholar
8. Torres, A, de la Bellacasa, JR, Xaubet, A, et al. Diagnostic value of quantitative cultures of bronchoalveolar lavage and telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia. Am Rev Respir Dis. 1989;140:306–310.Google Scholar
9. Papazian, L, Martin, C, Albanese, J, et al. Comparison of two methods of bacteriologic sampling of the lower respiratory tract: a study in ventilated patients with nosocomial bronchopneumonia. Crit Care Med. 1989;17:461–464.CrossRefGoogle ScholarPubMed
10. Pugin, J, Auckenthaler, R, Mili, N, et al. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991;143:1121–1129.Google Scholar
11. Bryant, LR, Trinkle, JK, Mobin-Uddin, K, et al. Bacterial colonization profile with tracheal intubation and mechanical ventilation. Arch Surg. 1972;104:647–651.Google Scholar
12. Murray, PR Washington, JA. Microscopic and bacteriologic analysis of expectorated sputum. Mayo Clin Proc. 1975;50:339–344.Google Scholar
13. Shlaes, DM, Lederman, M, Chmielewski, R, et al. Elastin fibers in the sputum of patients with necrotizing pneumonia. Chest. 1983;83:885–889.Google Scholar
14. Wunderink, RG, Russell, GB, Mezger, E, et al. The diagnostic utility of the antibody coated bacteria test in intubated patients. Chest. 1991;99:84–88.Google Scholar
15. Winterbauer, RH, Hutchinson, JE Reinhardt, N, et al. The use of quantitative cultures and antibody coating of bacteria to diagnose bacterial pneumonia by fiberoptic bronchoscopy. Am Rev Respir Dis. 1983;128:98–103.Google Scholar
16. Wimberly, N, Faling, LJ Bartlett, JG. A fiberoptic bronchoscopy technique to obtain uncontaminated lower airway secretions for bacterial culture. Am Rev Respir Dis. 1979;119:337–343.Google Scholar
17. Kirkpatrick, MB Bass, JB. Quantitative bacterial cultures of bronchoalveolar lavage fluids and protected brush catheter specimens from normal subjects. Am Rev Respir Dis. 1989;139:546–548.Google Scholar
18. Wimberly, NW, Bass, JB, Boyd, SW, et al. Use of a bronchoscopic protected catheter brush for the diagnosis of pulmonary infections. Chest. 1982;81:556–562.Google Scholar
19. Pollock, HM, Hawkins, EL, Bonner, JR, et al. Diagnosis of bacterial pulmonary infections with quantitative protected catheter cultures obtained during bronchoscopy. I Clin Microbiol. 1983;17:255–259.Google Scholar
20. Bartlett, JG Finegold, SM. Bacteriology of expectorated sputum with quantitative culture and wash techniques compared to transtracheal aspirates. Am Rev Respir Dis. 1978;117:1019–1027.Google Scholar
21. Chastre, J, Vian, F, Brun, P, et al. Prospective evaluation of the protected specimen brush for the diagnosis of pulmonary infection in ventilated patients. Am Rev Respir Dis. 1984;130:924–929.Google Scholar
22. Fagon, JY, Chastre, J, Hanc, AJ, et al. Detection of nosocomial lung infection in ventilated patients: use of a protected specimen brush and quantitative culture techniques in 147 patients. Am Rev Respir Dis. 1988;138:110–116.Google Scholar
23. Chastre, J, Fagon, JY, Soler, R et al. Diagnosis of nosocomial bacterial pneumonia in intubated patients undergoing ventilation: comparison of the usefulness of the bronchoalveolar lavage and the protected specimen brush. Am J Med. 1988;85:499–506.Google Scholar
24. Chastre, J. Fagon, JY, Soler, P, et al. Quantification of BAL cells containing intracellular bacteria rapidly identities ventilated patients with nosocomial pneumonia. Chest. 1989;95:190S–192S.Google Scholar
25. deCastro, FR, Violan, JS, Capuz, BL, et al. Reliability of the bronchoscopic protected catheter brush in the diagnosis of pneumonia in mechanically ventilated patients. Crit Care Med. 1991;19:171–175.Google Scholar
26. Meduri, GU, Beals, DH, Maijub, AG, et al. Protected bronoalveolar lavage: a new bronchoscopic technique to retrieve uncon-taminated distal airway secretions. Am Rev Respir Dis. 1991;143:855–864.Google Scholar
27. Pham, LH, Brun-Buisson, C, Legrand, P. Diagnosis of nosocomial pneumonia in mechanically ventilated patients: comparison of a plugged telescoping catheter with the protected specimen brush. Am Rev Respir Dis. 1991;143:1055–1061.Google Scholar
28. Teague, RB, Wallace, RJ Awe, RJ. The use of quantitative sterile brush culture and Gram stain analysis in the diagnosis of lower respiratory tract infection. Chest. 1981;79:157–161.Google Scholar
29. Rein, ME Mandell, GL. Bacterial killing by bacteriostatic saline solutions-potential for diagnostic error. N Engl J Med. 1973;298:794–795.Google Scholar
30. Edelstein, PH, Meyer, RD: Legionnaire's disease: a review. Chest. 1984;85:114–120.Google Scholar
31. Bordelon, JY, Legrand, P, Gewin, WC, et al. The telescoping plugged catheter in suspected anaerobic infections. Am Rev Respir Dis. 1978;128:465–468.Google Scholar
32. Linder, J Rennard, S. Bronchoalveolar Lavage. 1st ed. Chicago, Ill: ASCP Press; 1988:1–44.Google Scholar
33. Thorpe, JE, Baughman, RP, Frame, PT, et al. Bronchoalveolar lavage for diagnosing acute bacterial pneumonia. J Infect Dis. 1987;155:855–861.Google Scholar
34. Kahn, FW Jones, JM. Diagnosing bacterial respiratory infection by bronchoalveolar lavage. J Infect Dis. 1987;155:862–869.Google Scholar
35. Guerra, LF, Baughman, RP, Use of bronchoalveolar lavage to diagnose bacterial pneumonia in mechanically ventilated patients. Crit Care Med. 1990;18:169–173.Google Scholar
36. Rouby, JJ, Rossignon, MD, Nicolas, MH, et al. A prospective study of protected bronchoalveolar lavage in the diagnosis of nosocomial pneumonia. Anesthesiology. 1989;71:679–685.Google Scholar
37. Gaussorgues, P, Piperno, D, Bachmann, P, et al. Comparison of nonbmnchoscopic bronchoalveolar lavage to open lung biopsy for the bacteriologic diagnosis of pulmonary infections in mechanically ventilated patients. Int Cure Med. 1989;15:94–98.Google Scholar
38. Johanson, WG, Seidenfeld, JJ, Gomez, P, et al. Bacteriologic diagnosis ofnosocomialpneumoniafollowingprolonged mechanical ventilation. Am Rev Respir Dis. 1988;137:259–264.Google Scholar
39. BAL Cooperative Group Steering Committee. Bronchoalveolar lavage constituents in healthy individuals, idiopathic pulmonary fibrosis, and selected comparison groups: 5. Cells in bronchoalveolar lavage fluid. Am Rev Respir Dis. 1990;141 (suppl):S175–S78.Google Scholar
40. Daniele, RP, Dantzker, DR, Davis, GS, et al. Clinical role of bmnchoalveolar lavage in adults with pulmonary disease. Am Rev Respir Dis. 1990;142:481–486.Google Scholar
41. Warner, DO, Warner, MA Divertie, MB. Open lung biopsy in patients with diffuse pulmonary infiltrates and acute respiratory failure. Am Rev Respir Dis. 1988;137:90–94.Google Scholar
42. Knapp, BE Kent, TH. Postmortem lung cultures. Arch Pathol. 1968;85:200–203.Google ScholarPubMed
43. Wilson, WR, Dolan, CT, Washington, JA, et al. Clinical significance of postmortem cultures. Arch Pathol. 1972;94:244–249.Google Scholar
44. DuMoulin, GC, Paterson, DG. Clinical relevance of postmortem microbiologic examination: a review. Hum Pathol. 1985;16:539548.Google Scholar
45. Cockerill, FR, Wilson, WR Carpenter, HA. Open lung biopsy in immunocompromised patients. Arch Intern Med. 1985;145:1398–1404.Google Scholar
46. Ashbaugh, DG, Maier, RV. Idiopathic pulmonary fibrosis in adult resujratory distress syndrome. Arch Surg. 1985:120:530–535.Google Scholar
47. Meduri, GU Belenchia, JM. Estes, RJ, et al. Fibroproliferative phase of ARDS: clinical findings and effects of corticosteroids. Chest. 1991;100:943–952.Google Scholar
48. Nelems, JM, Cooper, JD, Henderson, MB, et al. Emergency open lung biopsy. Ann Thorac Surg. 1986;260–264.Google Scholar
49. Newman, SL, Michel, RP Wang, NS. Lingular lung biopsy: is it representative? Am Rev Respir Dis. 1985;132:1084–1086.Google ScholarPubMed
50. Katzenstein, AA Askin, FB. Surgical Pathology of Nonneoplastic Lung Disease. 2nd ed. Philadelphia, Pa: WB Saunders; 1990.Google Scholar