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Başlık: Nonbronchoscopic bronchoalveolar lavage for diagnosing ventilator-associated pneumonia in newborns
Yazarlar: Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.
Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Mikrobiyoloji Anabilim Dalı.
Köksal, Nilgün
Hacımustafaoğlu, Mustafa
Çelebi, Solmaz
Özakın, Cüneyt
7003323615
6602154166
7006095295
57200678942
Anahtar kelimeler: Pediatrics
Ventilator-associated pneumonia
Sepsis
Premature
Mechanical ventilation
Newborn
Nonbronchoscopic bronchoalveolar lavag
Fluid
Accuracy
Risk-factors
Nosocomial pneumonia
Protected specimen brush
Yayın Tarihi: 2006
Yayıncı: Türk Milli Pediatri Derneği
Atıf: Köksal, N. vd. (2006). ''Nonbronchoscopic bronchoalveolar lavage for diagnosing ventilator-associated pneumonia in newborns''. Turkish Journal of Pediatrics, 48(3), 213-220.
Özet: The appropriate treatment of ventilator-associated pneumonia (VAP) must be based on accurate diagnosis, which can be done by microbiological examination of the samples obtained from the respiratory tract by nonbronchoscopic bronchoalveolar lavages (NB-BAL). This study was designed to determine the effectiveness of NB-BAL in diagnosing VAP in newborns. Two hundred and seven NB-BAL samples were obtained from 145 intubated neonates for microbiologic and cytologic evaluation of the distal air-way. The NB-BAL samples were processed for microscopic quantification of the polymorphonuclear cells (PMN) containing intracellular bacteria (ICB) and quantitative culture (positive threshold, 10(5) cfu/ml). VAP was defined as a new, progressive, or persistent (>24 hrs) infiltrate on the chest radiograph, with two or more of the following criteria: a) macroscopically purulent tracheal secretions, b) fever or hypothermia, c) leukocytosis or leukopenia, and d) worsening of respiratory status with a Pa O-2/F IO2 ratio of <240. Colonization was defined as mechanical ventilation for more than seven days, no signs of infection, and isolation of the same bacteria species in two previously obtained NB-BAL samples. Of the 145 neonates, 40 (27.5%) were infected and 12 (8.3%) were colonized. Forty-four patients (30%) developed VAP according to diagnostic categories based on clinical and radiologic criteria. Forty newborns with VAP (90%) had positive NB-BAL culture. The sensitivity, specificity, and positive and negative predictive values of NB-BAL fluid culture for VAP diagnosis were 90%, 90%, 70%, and 97%, respectively. The percentage of ICB was significantly higher in newborns with VAP. The presence of ICB in 2% or more on Giemsa-stained smears corresponded to a sensitivity of 94%, specificity of 83%, positive predictive value of 94%, and negative predictive value of 83%. The sensitivity and specificity of combination of ICB and NB-BAL quantitative culture in diagnostic samples were 94% and 90%, respectively. The positive and negative predictive values were 71% and 98%. In our study, the presence of leukocytes in the NB-BAL fluid smear of infants with VAP was higher than that of the colonized babies (84%, 26%). This difference was statistically significant (p<0.0001). The sensitivity and specificity of PMNs in NB-BAL fluid for the diagnosis were 86% and 75%, respectively, and the positive and negative predictive values were 89% and 69%. We conclude that NB-BAL lavage is well tolerated and clinically useful in mechanically ventilated newborns. These results suggest that NB-BAL fluid microscopic examination and cultures can offer a sensitive and specific means to diagnose VAP in newborns and may provide relevant information about the causative pathogens.
URI: https://www.turkishjournalpediatrics.org/uploads/pdf_TJP_339.pdf
http://hdl.handle.net/11452/22728
ISSN: 0041-4301
Koleksiyonlarda Görünür:Scopus
TrDizin
Web of Science

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