El Solh Ali A, Akinnusi Morohunfolu E, Pineda Lilibeth A, Mankowski Corey R
Western New York Respiratory Research Center, Department of Medicine, State University of New York, Buffalo School of Medicine and Biomedical Sciences, Grider Street Buffalo, New York 14215, USA.
Crit Care. 2007;11(3):R57. doi: 10.1186/cc5917.
Diagnostic strategies based on tracheal aspirates in patients with severe nursing home-acquired pneumonia have not previously been evaluated. The objectives of the study were to investigate, in patients with severe nursing home-acquired pneumonia, the diagnostic value of quantitative endotracheal aspirate (QEA) cultures using increasing interpretative cutoff points, as compared with bronchoalveolar lavage (BAL) and protected specimen brush (PSB) quantitative cultures.
Seventy-five nursing home patients requiring mechanical ventilation for suspected pneumonia were studied. Endotracheal aspirate, PSB, and BAL samples were obtained consecutively. The diagnostic yield of QEA at thresholds raging from 10(3) to 10(7) colony-forming units (cfu)/ml was assessed by calculating sensitivities, specificities, and accuracy rates. A receiver operator characteristic curve for the series of cutoff points was constructed.
Forty-nine patients were diagnosed with pneumonia either by BAL (<or= 10(4) cfu/ml) or PSB (<or= 10(3) cfu/ml). Diagnostic accuracy of QEA was most favorable at 10(4) cfu/ml. At this threshold, endotracheal aspirates coincided with both BAL and PSB in 30 cases, whereas partial agreement was observed in 14 cases. This resulted in sensitivity and specificity of 90% (95% confidence interval 78% to 97%) and 77% (95% confidence interval 56% to 91%), respectively. QEA findings correlated significantly with both PSB and BAL quantitative cultures (r = 0.71 [P < 0.001] and r = 0.77 [P < 0.001], respectively).
QEA may be used as a diagnostic tool to determine the presence of pneumonia in ventilated patients admitted from nursing homes when bronchoscopic procedures are not feasible or available.
此前尚未对基于气管吸出物的诊断策略在严重养老院获得性肺炎患者中的应用进行评估。本研究的目的是，在患有严重养老院获得性肺炎的患者中，与支气管肺泡灌洗（BAL）和保护性标本刷检（PSB）定量培养相比，研究使用不断增加的解释性临界值的定量气管吸出物（QEA）培养的诊断价值。
对75名因疑似肺炎而需要机械通气的养老院患者进行了研究。连续获取气管吸出物、PSB和BAL样本。通过计算敏感性、特异性和准确率，评估QEA在10³至10⁷菌落形成单位（cfu）/毫升阈值下的诊断率。构建了一系列临界值的受试者工作特征曲线。
49名患者通过BAL（≤10⁴ cfu/ml）或PSB（≤10³ cfu/ml）被诊断为肺炎。QEA的诊断准确性在10⁴ cfu/ml时最为有利。在此阈值下，气管吸出物在30例中与BAL和PSB一致，而在14例中观察到部分一致。这导致敏感性和特异性分别为90%（95%置信区间78%至97%）和77%（95%置信区间从56%至91%）。QEA结果与PSB和BAL定量培养均显著相关（分别为r = 0.71 [P < 0.001]和r = 0.77 [P < 0.001]）。
当支气管镜检查不可行或无法进行时，QEA可作为一种诊断工具，用于确定从养老院收治的接受通气治疗患者中是否存在肺炎。
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