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Correlation of intracellular organisms with quantitative endotracheal aspirate
Karen J Brasel1, Brian Allen, Chuck Edmiston
1Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. kbrasel@mcw.edu.
Background:
The presence of intracellular organisms (ICOs) in polymorphonuclear cells obtained from respiratory secretions is a possible method for rapid diagnosis of ventilator-associated pneumonia. We correlated ICOs with quantitative endotracheal aspirate (QA) in intubated patients.
Methods:
Consecutive intubated patients in the surgical intensive care unit had respiratory samples obtained every 2 days until extubation. Two thresholds for ICOs and quantitative culture were examined. Sensitivity, specificity, and positive and negative predictive values were calculated using QA as reference.
Results:
One hundred one samples were obtained from 35 patients. Colony counts >or= 100,000 were found in 34 samples; 60 samples had colony counts >or= 10,000. Antibiotic use did not affect the sensitivity or specificity of ICOs. Sensitivity of ICOs was 39% to 85%, and specificity was 82% to 97%. Positive predictive value was 70% to 96%, and negative predictive value was 50% to 91%.
Conclusion:
ICOs provide a quick method for establishing the presence of a significant bacterial load in the respiratory tract. Accuracy of ICOs in predicting a positive QA is not affected by concurrent antibiotics.
Insights
Intracellular organisms (ICOs) in respiratory samples offer rapid diagnosis for ventilator-associated pneumonia. This method accurately identifies bacterial load, even with antibiotic use.
Area of Science:
- Microbiology
- Critical Care Medicine
- Infectious Diseases
Background:
- Ventilator-associated pneumonia (VAP) diagnosis can be challenging.
- Rapid diagnostic methods are crucial for timely VAP treatment.
- Intracellular organisms (ICOs) in polymorphonuclear cells are a potential rapid diagnostic marker.
Purpose of the Study:
- To correlate ICO presence in respiratory secretions with quantitative endotracheal aspirate (QA) cultures.
- To evaluate ICOs as a rapid diagnostic tool for VAP in intubated patients.
Main Methods:
- Respiratory samples collected every 2 days from intubated surgical ICU patients.
- Two ICO thresholds and quantitative culture examined.
- Sensitivity, specificity, and predictive values calculated using QA as reference.
Main Results:
- 101 samples from 35 patients analyzed.
- ICOs showed sensitivity of 39%-85% and specificity of 82%-97%.
- Positive predictive value ranged from 70%-96%; negative predictive value from 50%-91%.
Conclusions:
- ICOs provide a rapid method to detect significant bacterial load in respiratory tracts.
- ICO accuracy in predicting positive QA is not impacted by concurrent antibiotic therapy.