0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
ARTICLE |

Relationship of Microbiologic Diagnostic Criteria to Morbidity and Mortality in Patients With Ventilator-Associated Pneumonia

Fabienne Bregeon, MD; Laurent Papazian, MD; Alexandre Visconti, MD; Régine Gregoire, MD; Xavier Thirion, MD; François Gouin, MD
JAMA. 1997;277(8):655-662. doi:10.1001/jama.1997.03540320057036.
Text Size: A A A
Published online

Objective.  —To evaluate whether the mortality and the morbidity of ventilatorassociated pneumonia, defined by positive result of protected specimen brush culture, was different from that defined by other methods.

Design.  —Matched-cohort study. All patients with clinical suspicion of pneumonia were investigated with protected specimen brush, bronchoalveolar lavage, and blind bronchial samplings. Two groups were defined: brush-positive patients (positive culture of the protected specimen brush) and brush-negative patients (negative culture of the protected specimen brush, but positive culture with another method).

Setting.  —A 14-bed medicosurgical intensive care unit (ICU) in an 850-bed teaching hospital.

Patients.  —All patients with documented ventilator-associated pneumonia over 4 years 9 months. A total of 102 cases documented by protected specimen brush culture and 223 documented by another sampling procedure. Patients were matched according to diagnosis on admission, age, sex, date of admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and date of onset of pneumonia.

Main Outcome Measures.  —Mortality rate, duration of mechanical ventilation, duration of ICU stay, duration of hospital stay, sampling methods, and microbiologic cultures.

Results.  —A total of 76 pairs were submitted for analysis. The effectiveness of matching was 81.85%. There was no difference in mortality between brush-positive patients and brush-negative patients. The ICU fatality rate was 38% in the brushpositive group and 39.4% in the brush-negative group (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.46-1.93). The hospital fatality rate was 41% (OR, 1; 95% CI, 0.5-2.01). The mean (SD) duration of ventilation was 26(23) days in the 2 groups (range, 3-132 days). The duration of ICU stay was 33 (27.4) days in the 2 groups (range, 3-152 days).

Conclusions.  —When confounding factors are controlled, patient outcome is the same if ventilator-associated pneumonia has been diagnosed by protected specimen brush or by another sampling method.

Topics

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();