TY - JOUR
T1 - Microbiologic surveillance through subglottic secretion cultures during invasive mechanical ventilation
T2 - a prospective observational study
AU - Bello, Giuseppe
AU - Bisanti, Alessandra
AU - Giammatteo, Valentina
AU - Montini, Luca
AU - Eleuteri, Davide
AU - Fiori, Barbara
AU - La Sorda, Marilena
AU - Spanu, Teresa
AU - Grieco, Domenico L.
AU - Pennisi, Mariano A.
AU - De Pascale, Gennaro
AU - Antonelli, Massimo
N1 - Funding Information:
None. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. GB, AB and VG had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. GB and GDP conceived the study protocol. GB, AB, VG, LM, DE, BF, MLS, TS, DLG, MAP, GDP, and MA participated in the design and development of the database, helped in analysis and interpretation of data, helped in drafting of the manuscript and critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript. The protocol was preapproved by the local ethics committee (Comitato Etico Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UCSC; approval number, 28739/17). Written informed consent was obtained from all enrolled patients or their next of kin prior to study entry. The study is registered with ClinicalTrials.gov (NCT03153241). The authors declare that they have no competing interests.
Publisher Copyright:
© 2020 Elsevier Inc.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/10
Y1 - 2020/10
N2 - Purpose: Whether subglottic secretions (SS) culture during invasive mechanical ventilation may aid microbiological surveillance is unknown. We conducted a prospective study to assess SS cultures predictivity of endotracheal aspirate (ETA) and bronchoalveolar lavage (BAL) isolates. Materials and methods: 109 patients receiving mechanical ventilation for ≥48 hours underwent SS and ETA surveillance cultures twice weekly; blind BAL was performed in case of clinically suspected pneumonia. Results: SS and ETA cultures were fully concordant in 170 (81%-overall accuracy) of 211 sample pairs. As compared to ETA, SS culture global sensitivity and specificity were 84% [95%CI: 77 to 91] and 74% [95%CI: 66 to 82]; negative and positive predictive values were 82% and 77%. Forty-four episodes of clinically suspected pneumonia were observed. Compared to BAL, SS culture global sensitivity and specificity were 68% [95%CI: 45 to 81] and 63% [95%CI: 44 to 82]; negative and positive predictive values were both 65%. SS sensitivity, specificity, positive and negative predictive values in anticipating BAL isolates were comparable to ETA (all p > 0.20). Conclusions: SS cultures show worthy accuracy in identifying ETA isolates, with excellent sensitivity and good negative predictivity. SS cultures may be not inferior to ETA in predicting BAL results in case of ventilator-associated pneumonia. Trial registration: ClinicalTrials.gov, NCT03153241. Registered on 15 May 2017, https://clinicaltrials.gov/ct2/show/NCT03153241
AB - Purpose: Whether subglottic secretions (SS) culture during invasive mechanical ventilation may aid microbiological surveillance is unknown. We conducted a prospective study to assess SS cultures predictivity of endotracheal aspirate (ETA) and bronchoalveolar lavage (BAL) isolates. Materials and methods: 109 patients receiving mechanical ventilation for ≥48 hours underwent SS and ETA surveillance cultures twice weekly; blind BAL was performed in case of clinically suspected pneumonia. Results: SS and ETA cultures were fully concordant in 170 (81%-overall accuracy) of 211 sample pairs. As compared to ETA, SS culture global sensitivity and specificity were 84% [95%CI: 77 to 91] and 74% [95%CI: 66 to 82]; negative and positive predictive values were 82% and 77%. Forty-four episodes of clinically suspected pneumonia were observed. Compared to BAL, SS culture global sensitivity and specificity were 68% [95%CI: 45 to 81] and 63% [95%CI: 44 to 82]; negative and positive predictive values were both 65%. SS sensitivity, specificity, positive and negative predictive values in anticipating BAL isolates were comparable to ETA (all p > 0.20). Conclusions: SS cultures show worthy accuracy in identifying ETA isolates, with excellent sensitivity and good negative predictivity. SS cultures may be not inferior to ETA in predicting BAL results in case of ventilator-associated pneumonia. Trial registration: ClinicalTrials.gov, NCT03153241. Registered on 15 May 2017, https://clinicaltrials.gov/ct2/show/NCT03153241
KW - Intensive care unit
KW - Mechanical ventilation
KW - Respiratory system diagnostic techniques
KW - Ventilator-associated pneumonia
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U2 - 10.1016/j.jcrc.2020.05.013
DO - 10.1016/j.jcrc.2020.05.013
M3 - Article
C2 - 32516641
AN - SCOPUS:85085921632
VL - 59
SP - 42
EP - 48
JO - Journal of Critical Care
JF - Journal of Critical Care
SN - 0883-9441
ER -