This Article  • References  • Full text PDF  • Correction  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (36)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Fabienne Bregeon, MD; Laurent Papazian, MD; Alexandre Visconti, MD; Régine Gregoire, MD; Xavier Thirion, MD; François Gouin, MD

JAMA. 1997;277(8):655-662.

Abstract
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.

Author Affiliations
From the Department of Anesthesia and Intensive Care (Drs Bregeon, Papazian, Visconti, and Gouin) and the Department of Medical Information (Drs Gregoire and Thirion), Hôpital Sainte-Marguerite, Marseille, France.

Footnotes
Reprints: Fabienne Bregeon, MD, Département d'Anesthésiology-Réanimation, Hôpital Sainte-Marguerite, 13274 Marseille Cedex 9, France.

Concepts in Emergency and Critical Care section editor: Roger C. Bone, MD, Consulting Editor, JAMA.

Advisory Panel: Bart Chernow, MD, Baltimore, Md; David Dantzker, MD, New Hyde Park, NY; Jerrold Leiken, MD, Chicago, III; Joseph E. Parrillo, MD, Chicago, III; William J. Sibbald, MD, London, Ontario; and Jean-Louis Vincent, MD, PhD, Brussels, Belgium.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Diagnosis and treatment of ventilator-associated pneumonia.
Porzecanski and Bowton
Chest 2006;130:597-604.
ABSTRACT | FULL TEXT  

Oral Decontamination with Chlorhexidine Reduces the Incidence of Ventilator-associated Pneumonia
Koeman et al.
Am. J. Respir. Crit. Care Med. 2006;173:1348-1355.
ABSTRACT | FULL TEXT  

Cultures and Ventilator-Associated Pneumonia : Not How, But How Many
Bowton
Chest 2002;122:401-402.
FULL TEXT  

A Randomized Clinical Trial of Intermittent Subglottic Secretion Drainage in Patients Receiving Mechanical Ventilation
Smulders et al.
Chest 2002;121:858-862.
ABSTRACT | FULL TEXT  

Ventilator-Associated Pneumonia
Morehead and Pinto
Arch Intern Med 2000;160:1926-1936.
ABSTRACT | FULL TEXT  

Noninvasive Versus Invasive Microbial Investigation in Ventilator-associated Pneumonia . Evaluation of Outcome
RUIZ et al.
Am. J. Respir. Crit. Care Med. 2000;162:119-125.
ABSTRACT | FULL TEXT  

Multicenter Prospective Study of Ventilator-Associated Pneumonia During Acute Respiratory Distress Syndrome . Incidence, Prognosis, and Risk Factors
MARKOWICZ et al.
Am. J. Respir. Crit. Care Med. 2000;161:1942-1948.
ABSTRACT | FULL TEXT  

Fever in the ICU
Marik
Chest 2000;117:855-869.
ABSTRACT | FULL TEXT  

A Randomized Clinical Trial of Continuous Aspiration of Subglottic Secretions in Cardiac Surgery Patients
Kollef et al.
Chest 1999;116:1339-1346.
ABSTRACT | FULL TEXT  

The Clinical Utility of Invasive Diagnostic Techniques in the Setting of Ventilator-Associated Pneumonia
Heyland et al.
Chest 1999;115:1076-1084.
ABSTRACT | FULL TEXT  

Nosocomial Pneumonia in the ICUYear 2000 and Beyond
Bowton
Chest 1999;115 :28S-33S.
ABSTRACT | FULL TEXT  

Risks and Routes for Ventilator-Associated Pneumonia with Pseudomonas aeruginosa
TALON et al.
Am. J. Respir. Crit. Care Med. 1998;157:978-984.
ABSTRACT | FULL TEXT  

Identifying the Causative Organism in Patients With Ventilator-Associated Pneumonia
Marik and Varon
JAMA 1997;278:24-25.
ABSTRACT