Diagnostic non invasif des pneumopathies nosocomiales acquises sous ventilation mécanique : comparaison entre le prélèvement distal protégé et l’aspiration endotrachéale

Abstract

Objective: Quantitative culture of endotracheal aspirates (EA) is widely accepted for the diagnosis of ventilator-associated pneumonia (VAP). The aim of the study was to compare the diagnostic accuracy of the EA with the blinded plugged telescoping catheter (PTC) in patients suspected of VAP. Study design: Prospective non-randomised observational study. Patients and methods: 31 patients suspected of having VAP underwent 46 bronchial samplings. An EA and a blinded PTC were performed successively in each case ; the PTC result was taken as the reference standard. The EA and PTC cultures were defined positive if the result of bacterial cultures yelding were ≥ 10 5 cfu·mL –1 and ≥ 10 3 cfu·mL –1 respectively. Results: The diagnosis of VAP could be established in 19 cases when PTC was taking as gold test. The overall agreement between the two techniques was 76 %. EA had a sensivity of 89.5%, a specificity of 66.7%, a negative predictive value of 90 % and a positive predictive value of 65.4%. Conclusion: EA is a good diagnostic test when a non-invasive test has been chosen. The diagnosis of VAP could be excluded in 90 % of cases when the EA cultures yelding were <10 5 cfu·mL –1. His low specificity could drive in an over treatment of bronchopulmonar bacterial colonization. The accuracy of the EA compares well with that of the TPC for the diagnostic of VAP.