Gürgün Alev, Korkmaz Ekren Pervin, Bacakoğlu Feza, Başoğlu Ozen Kaçmaz, Dirican Nigar, Aydemir Şöhret, Nart Deniz, Sayıner Abdullah
Department of Chest Diseases, Faculty of Medicine, Ege University, Izmir, Turkey.
Tuberk Toraks. 2013;61(4):288-94. doi: 10.5578/tt.6610.
Ventilator associated pneumonia (VAP) is one of the most important causes of mortality in patients treated with invasive mechanical ventilation (IMV) in intensive care unit (ICU). Microbiological examinations are required as clinical and radiological findings are usually insufficient in the diagnosis.
Twenty four patients who were receiving IMV because of respiratory failure, had a Clinical Pulmonary Infection Score (CPIS) of ≥ 6 in the follow-up and died with the suspicion of VAP were enrolled in our study. Six patients were excluded as post-mortem biopsy could not be performed. The patients who had pre-mortem CPIS ≥ 6, in whom a causative organism was identified from the culture of post-mortem lung biopsy and/or histopathological examination of lung biopsy was compatible with pneumonia were diagnosed as VAP. In the 18 patients in whom a post-mortem lung biopsy was performed, quantitative culture results of endotracheal aspirate performed 48 hours prior to death were compared with microbiological and histopathological results of post-mortem lung biopsy specimens, and the role of endotracheal aspirate in the diagnosis of VAP was evaluated retrospectively.
Out of 18 patients (12 men, mean age 67.0 ± 13.0 years) included in the study, 11 (61.1%) were diagnosed as VAP. The quantitative culture of endotracheal aspirate was positive in 9 (81.8%) out of 11 patients diagnosed as VAP. The sensitivity, specificity, positive and negative predictive values of endotracheal aspirate culture for identifying VAP were found to be 81.8%, 14.3%, 60.0% and 33.3%, respectively.
Our study shown that quantitative culture of endotracheal aspirate is a practical and reliable method that can be used for the diagnosis of VAP in patients receiving IMV in ICU and having CPIS ≥ 6.
呼吸机相关性肺炎（VAP）是重症监护病房（ICU）中接受有创机械通气（IMV）治疗患者最重要的死亡原因之一。由于临床和影像学检查结果在诊断中通常不足，因此需要进行微生物学检查。
本研究纳入了24例因呼吸衰竭接受IMV治疗、随访时临床肺部感染评分（CPIS）≥6且疑似VAP死亡的患者。6例因无法进行尸检活检而被排除。将生前CPIS≥6、尸检肺活检培养物中鉴定出致病微生物和/或肺活检组织病理学检查与肺炎相符的患者诊断为VAP。在18例进行了尸检肺活检的患者中，将死亡前48小时进行的气管内吸出物定量培养结果与尸检肺活检标本的微生物学和组织病理学结果进行比较，回顾性评估气管内吸出物在VAP诊断中的作用。
纳入研究的18例患者（12例男性，平均年龄67.0±13.0岁）中，11例（61.1%）被诊断为VAP。在11例诊断为VAP 的患者中，9例（81.8%）气管内吸出物定量培养呈阳性。气管内吸出物培养用于识别VAP的敏感性、特异性、阳性和阴性预测值分别为81.8%、14.3%、60.0%和33.3%。
我们的研究表明，气管内吸出物定量培养是一种实用且可靠的方法，可用于诊断ICU中接受IMV且CPIS≥6的患者的VAP。
