Implementation of bronchoscopic techniques in the diagnosis of ventilator-associated pneumonia to reduce antibiotic use.
In intensive care units, a large proportion of antibiotics are prescribed for presumed episodes of ventilator-associated pneumonia (VAP).
VAP is usually diagnosed on a combination of clinical, radiographic, and microbiologic criteria with a high sensitivity but low specificity for VAP.
As a result, patients may receive antibiotics unnecessarily.
Specificity can be increased by the addition of quantitative cultures of samples of protected specimen brush (PSB) and bronchoalveolar lavage (BAL) to the diagnostic criteria.
We prospectively analyzed the effects of implementation of PSB and BAL in the diagnosis of VAP on antibiotic prescription.
PSB and/or BAL were performed in patients who fulfilled the clinical, radiographic, and microbiologic criteria for VAP.
Based on quantitative cultures of PSB and/or BAL, patients were categorized into three groups :
VAP microbiologically proven (Group 1 ; n=72) ;
clinical suspicion of VAP not confirmed microbiologically (Group 2 ; n=66) ;
and patients in whom bronchoscopy could not be performed (Group 3 ; n=17).
In Group 1, antibiotic therapy was instituted empirically in 40 patients (56%) (Group la) and after obtaining culture results in the other 32 patients (Group 1b).
Adjustment of therapy, based on culture results, occurred in 14 (35%) patients in Group la.
In Group 2, empiric therapy was instituted in 34 (52%) patients (Group 2a) and discontinued within 48 h in 17 of them (50%). (...)
Mots-clés Pascal : Pneumonie, Bactériose, Infection, Infection nosocomiale, Unité soin intensif, Ventilation artificielle, Complication, Bronchoscopie, Diagnostic, Iatrogène, Antibiotique, Antibactérien, Chimiothérapie, Traitement, Prescription médicale, Economie santé, Homme, Appareil respiratoire pathologie, Poumon pathologie, Endoscopie
Mots-clés Pascal anglais : Pneumonia, Bacteriosis, Infection, Nosocomial infection, Intensive care unit, Artificial ventilation, Complication, Bronchoscopy, Diagnosis, Iatrogenic, Antibiotic, Antibacterial agent, Chemotherapy, Treatment, Medical prescription, Health economy, Human, Respiratory disease, Lung disease, Endoscopy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0051697
Code Inist : 002B02S02. Création : 14/05/1998.