Diagnostic Tools for Ventilator-Associated Pneumonia

  • T. Bauer
  • R. Ferrer
  • A. Torres
Conference paper
Part of the Topics in Anaesthesia and Critical Care book series (TIACC)


Nosocomial pneumonia and ventilator-associated pneumonia (VAP, nosocomial pneumonia after 48 h of mechanical ventilation) are currently the second leading cause of nosocomial infections and account for approximately 10% to 15% of all hospital-acquired infections [1–3]. The incidence of nosocomial pneumonia is increased for all patients in intensive care units (ICU), where respiratory infections have been reported to be the most frequent type of nosocomial infections [4]. During the last 10 years, several diagnostic methods have been developed to microbiologically confirm the clinical diagnosis, especially in mechanically ventilated patients [5]. These methods require the use of bacterial quantitative cultures and for each method a specific bacterial threshold is accepted for the confirmation of a pulmonary infection [6]. However, despite the enormous amount of literature regarding this topic, there is still an open debate about the requirement of invasive fiberoptic bronchoscopic techniques [7–10].


Nosocomial Infection Respir Crit Nosocomial Pneumonia Quantitative Culture Endotracheal Aspirate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    American Thoracic Society (1996) Hospital-acquired pneumonia in adults: diagnosis, assessment, initial therapy, and prevention: a consensus statement. Am J Respir Grit Care Med 153: 1711–1725CrossRefGoogle Scholar
  2. 2.
    Barsic B, Beus I, Marton E et al (1999) Nosocomial infections in critically ill infectious disease patients: results of a 7-year focal surveillance. Infection 27: 16–22PubMedCrossRefGoogle Scholar
  3. 3.
    Kampf G, Wischnewski N, Schulgen G et al (1999) Prevalence and risk factors for nosocomial lower respiratory tract infections in German hospitals. J Clin Epidemiol 51: 495-502CrossRefGoogle Scholar
  4. 4.
    Richards MJ, Edwards JR, Culver DH, Gaynes RP (1999) Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 27: 887–892Google Scholar
  5. 5.
    Bowton DL (1999) Nosocomial pneumonia in the ICU-year 2000 and beyond. Chest 115: 28s - 33sPubMedCrossRefGoogle Scholar
  6. 6.
    Reimer LG, Carroll KC (1998) Role of the microbiology laboratory in the diagnosis of lower respiratory tract infections. Clin Infect Dis 26: 742–748PubMedCrossRefGoogle Scholar
  7. 7.
    Niederman M, Torres A, Summer W (1994) Invasive diagnostic testing is not needed routinely to manage suspected ventilator-associated pneumonia. Am J Respir Grit Care Med 150: 565–569CrossRefGoogle Scholar
  8. 8.
    Chastre J, Fagon JY (1994) Invasive diagnostic testing should be routinely used to manage ventilated patients with suspected pneumonia. Am J Respir Crit Care Med 150: 570574Google Scholar
  9. 9.
    Baughman RP, Tapson V, McIvor A (1999) The diagnosis and treatment challenges in nosocomial pneumonia. Diagn Microbiol Infect Dis 33: 131–139PubMedCrossRefGoogle Scholar
  10. 10.
    Bruchhaus JD, McEachern R, Campbell GDJ (1998) Hospital-acquired pneumonia: recent advances in diagnosis, microbiology and treatment. Curr Opin Pulm Med 4: 180184Google Scholar
  11. 11.
    Johanson WG, Pierce AK, Sanford JP, Thomas GD (1972) Nosocomial respiratory infection with Gram-negative bacilli: the significance of colonization of the respiratory tract. Ann Intern Med 77: 701–706PubMedCrossRefGoogle Scholar
  12. 12.
    Andrews CP, Coalson JJ, Smith JD, Johanson WG (1981) Diagnosis of nosocomial bacterial pneumonia in acute, diffuse lung injury. Chest 80: 254–258PubMedCrossRefGoogle Scholar
  13. 13.
    Bell RC, Coalson JJ, Smith JD, Johanson WG (1983) Multiple organ failure and infection in adult respiratory distress syndrome. Ann Intern Med 99: 293–298PubMedCrossRefGoogle Scholar
  14. 14.
    Wunderink RG, Woldenberg LS, Zeiss J et al (1992) The radiologic diagnosis of autopsy-proven ventilator associated-pneumonia. Chest 101: 458–463PubMedCrossRefGoogle Scholar
  15. 15.
    Fàbregas N, Ewig S, Torres A et al (1999) Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate postmortem lung biopsies. Thorax 54: 867–873PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Pugin J, Auckenthaler R, Mili N et al (1991) Diagnosis of ventilator associated pneumonia by bacteriologic analysis of bronchoscopic and non-bronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis 143: 1121–1129PubMedCrossRefGoogle Scholar
  17. 17.
    Rouby JJ (1996) Histology and microbiology of ventilator-associated pneumonia. Semin Respir Infect 11: 54–60PubMedGoogle Scholar
  18. 18.
    Meduri GU, Mauldin GL, Wunderink RG et al (1994) Causes of fever and pulmonary densities in patients with clinical manifestations of ventilator-associated pneumonia. Chest 106: 221–235PubMedCrossRefGoogle Scholar
  19. 19.
    Wimberley L, Falling LJ, Bartlett JG (1979) A fiberoptic bronchoscopy technique to obtain uncontaminated lower airway secretions for bacterial culture. Am Rev Respir Dis 119: 337–343PubMedGoogle Scholar
  20. 20.
    Croce MA, Fabian TC, Waddle-Smith L et al (1998) Utility of Gram’s stain and efficacy of quantitative cultures for posttraumatic pneumonia: a prospective study. Ann Surg 227: 743–751PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Marquette CH, Herengt F, Saulnier R et al (1993) Protected specimen brush in the assessment of ventilator-associated pneumonia. Selection of a certain lung segment for bronchoscopic sampling is unnecessary. Chest 103: 243–247Google Scholar
  22. 22.
    Fàbregas N, Torres A, El-Ebiary M et al (1996) Histopathologic and microbiologic aspects of ventilator-associated pneumonia. Anesthesiology 84: 760–771PubMedCrossRefGoogle Scholar
  23. 23.
    Montravers P, Fagon JY, Chastre J et al (1993) Follow-up protected specimen brushes to assess treatment in nosocomial pneumonia. Am Rev Respir Dis 147: 38–44PubMedCrossRefGoogle Scholar
  24. 24.
    Dreyfuss D, Mier L, Le Bourdelles K et al (1993) Clinical significance of borderline quantitative protected specimen brush specimen culture results. Am Rev Respir Dis 147: 946–951PubMedCrossRefGoogle Scholar
  25. 25.
    Meduri GU, Chastre J (1992) The standardization of bronchoscopic techniques for ventilator-associated pneumonia. Chest 102: 557S - 564SPubMedCrossRefGoogle Scholar
  26. 26.
    Meduri GU, Beals DH, Maijub AG, Baselski V (1991) Protected bronchoalveolar lavage: a new bronchoscopic technique to retrieve uncontaminated distal airway secretions. Am Rev Respir Dis 143: 855–864PubMedCrossRefGoogle Scholar
  27. 27.
    Gerbeaux P, Ledoray V, Boussuges A et al (1998) Diagnosis of nosocomial pneumonia in mechanically ventilated patients: repeatability of the bronchoalveolar lavage. Am J Respir Crit Care Med 157: 76–80PubMedGoogle Scholar
  28. 28.
    Torres A, El-Ebiary M, Fàbregas N et al (1996) Value of intracellular bacteria detection in the diagnosis of ventilator associated pneumonia. Thorax 51: 378–384PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Meduri GU (1995) Diagnosis and differential diagnosis of ventilator-associated pneumonia. Clin Chest Med 16: 61–93PubMedGoogle Scholar
  30. 30.
    Berger R, Arango L (1985) Etiologic diagnosis of bacterial nosocomial pneumonia in seriously ill patients. Crit Care Med 13: 833–836PubMedGoogle Scholar
  31. 31.
    Salata RA, Lederman MM, Shales DM et al (1987) Diagnosis of nosocomial pneumonia in intubated, intensive care unit patients. Am Rev Respir Dis 135: 426–432PubMedGoogle Scholar
  32. 32.
    El-Ebiary M, Torres A, Gonzalez J et al (1993) Quantitative cultures of endotracheal aspirates for the diagnosis of ventilator-associated pneumonia. Am J Respir Crit Care Med 147: 1552–1557Google Scholar
  33. 33.
    Chastre J, Fagon JY, Trouillet JL (1995) Diagnosis and treatment of nosocomial pneumonia in patients in intensive care units. Clin Infect Dis 21 [Suppl 31: 5226 - S237Google Scholar
  34. 34.
    Torres A, Puig de la Bellacasa J, Rodriguez RR et al (1988) Diagnostic value of telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia using the Metras catheter. Am Rev Respir Dis 138: 117–120PubMedCrossRefGoogle Scholar
  35. 35.
    Pham LH, Brun-Buisson C, Legrand P et al (1991) Diagnosis of nosocomial pneumonia in mechanically ventilated patients: comparison of a plugged telescoping catheter with the protected specimen brush. Am Rev Respir Dis 143: 1055–1061PubMedCrossRefGoogle Scholar
  36. 36.
    Rouby JJ, Rossignon MD, Nicolas MH et al (1989) A prospective study of protected bronchoalveolar lavage in the diagnosis of nosocomial pneumonia. Anesthesiology 71: 179–185CrossRefGoogle Scholar
  37. 37.
    Gaussorgues P, Piperno D, Bachmann P et al (1989) Comparison of nonbronchoscopic bronchoalveolar lavage to open lung biopsy for the bacteriologic diagnosis of pulmonary infections in mechanically ventilated patients. Intensive Care Med 15: 94–98PubMedCrossRefGoogle Scholar
  38. 38.
    Kollef MH, Bock KR, Richards RD, Hearns ML (1995) The safety and diagnosis accuracy of minibronchoalveolar lavage in patients with suspected ventilator associated pneumonia. Ann Intern Med 122: 743–748PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia, Milano 2001

Authors and Affiliations

  • T. Bauer
  • R. Ferrer
  • A. Torres

There are no affiliations available

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