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1 September 2006 Supplement

Volume 43, Number S2
Clinical Infectious Diseases 2006;43:S106–S113
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4305S2-0012$15.00
DOI: 10.1086/504488
SUPPLEMENT ARTICLE

Quantitative Cultures for Diagnosing Ventilator‐Associated Pneumonia: A Critique

Shigeki Fujitani1 and

Victor L. Yu2

1Infectious Disease Section, West Los Angeles Healthcare Center, VA Greater Los Angeles Healthcare System, Los Angeles, California; 2Division of Infectious Diseases, VA Medical Center and University of Pittsburgh, Pittsburgh, Pennsylvania

The diagnosis of ventilator‐associated pneumonia has been clouded by uncertainty, because a reference standard has never been established. The use of invasive procedures to obtain respiratory tract samples for culture, with quantitation of the bacteria isolated, has been the approach most commonly advocated. Quantitation of bacteria from lower respiratory tract specimens can be used to distinguish colonization from infection. We review the invasive procedures (bronchoalveolar lavage, protected specimen brushing, nonbronchoscopic bronchoalveolar lavage, and blinded bronchial sampling), the methods of quantitation used, the types of catheters used, the sample collection methods, and the criteria used as cutoffs for the quantitative cultures. Quantitation of lower respiratory tract samples is inherently unstable from a mathematical perspective, given the variability in the volume of fluid instilled and reaspirated and the magnitude and complexity of the area being sampled. We also briefly review the use of quantitation for bacterial infections other than pneumonia, including urinary tract infection and catheter‐related bacteremia. The variability in both the methods and reference criteria in the studies reviewed show that the quantitation approach is neither standardized nor evidence based.

Reprints or correspondence: Dr. Victor L. Yu, Infectious Disease Section, VA Medical Center, University Drive C, Pittsburgh, PA 15240 ().

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Jean Chastre, Charles-Edouard Luyt, Alain Combes, and Jean-Louis Trouillet. (2006) Use of Quantitative Cultures and Reduced Duration of Antibiotic Regimens for Patients with Ventilator-Associated Pneumonia to Decrease Resistance in the Intensive Care Unit. Clinical Infectious Diseases 43:s2, S75-S81
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Abstract-Full Text-PDF Version (359 kB)
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