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To the Editor: In their study of the North American Silver-Coated Endotracheal Tube (NASCENT) randomized trial, Dr Kollef and colleagues¹ concluded that silver-coated endotracheal tubes reduced the incidence of ventilator-associated pneumonia (VAP) by 36% compared with uncoated tubes. The evidence they present, however, is more suggestive of an effect on endobronchial colonization than on clinically meaningful invasive disease.

First, the authors defined VAP as 10⁴ colony-forming units/mL or greater on quantitative culture of bronchoalveolar lavage (BAL) fluid. Although this definition has the advantage of being objective, it does not necessarily translate into histological VAP or clinically important disease.² The reported sensitivity of quantitative BAL culture is only 50% to 77% and the specificity is 58% to 95% relative to autopsy-confirmed VAP.^3-4

Second, 28 of 93 positive BALs (30%) yielded organisms that are typically considered nonpathogenic colonizers. These included coagulase-negative staphylococci, enterococci, yeast, and normal flora. Excluding these nonpathogenic organisms, 28 . . . [Full Text of this Article]

Michael Klompas, MD, MPH
mklompas@partners.org
Infection Control Department
Brigham and Women's Hospital
Boston, Massachusetts

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RELATED ARTICLE

Silver-Coated Endotracheal Tubes and Incidence of Ventilator-Associated Pneumonia: The NASCENT Randomized Trial
Marin H. Kollef, Bekele Afessa, Antonio Anzueto, Christopher Veremakis, Kim M. Kerr, Benjamin D. Margolis, Donald E. Craven, Pamela R. Roberts, Alejandro C. Arroliga, Rolf D. Hubmayr, Marcos I. Restrepo, William R. Auger, Regina Schinner, and for the NASCENT Investigation Group
JAMA. 2008;300(7):805-813.
ABSTRACT | FULL TEXT  

RELATED LETTER

Silver-Coated Endotracheal Tubes and Patient Outcomes in Ventilator-Associated Pneumonia—Reply
Marin H. Kollef, Bekele Afessa, and Antonio Anzueto
JAMA. 2008;300(22):2605-2606.
EXTRACT | FULL TEXT