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Diagnoses of Ventilator- Associated Pneumonia Similar

Bronchoalveolar lavage, endotracheal aspiration have similar outcomes

WEDNESDAY, Dec. 20 (HealthDay News) -- Two techniques for diagnosing ventilator-associated pneumonia -- bronchoalveolar lavage and endotracheal aspiration -- are similar in terms of clinical outcomes and antibiotic use, researchers report in the Dec. 21 issue of the New England Journal of Medicine.

Daren Heyland, M.D., from Kingston General Hospital in Ontario, Canada, and colleagues randomly assigned 740 patients in the intensive care unit with suspected ventilator-associated pneumonia to a diagnosis by either bronchoalveolar lavage with quantitative culture or by endotracheal aspiration with non-quantitative culture. Patients known to be infected with pseudomonas species or methicillin-resistant Staphylococcus aureus were not included. All patients were given antibiotics until culture results were available, after which a targeted therapy was used to discontinue, reduce or resume antibiotics.

The researchers found that the two groups were similar in terms of mortality, rates of targeted therapy, days alive without antibiotics, maximum organ-dysfunction scores and length of stay in the hospital or ICU.

"Given the rapid emergence of antimicrobial resistance and the limited number of new antimicrobial agents, clinicians treating patients with suspected ventilator-associated pneumonia not only must prescribe appropriate initial antimicrobial regimens to optimize outcomes but also must minimize the development of resistance by rigorously using a de-escalation strategy," states an accompanying editorial. "When applied properly, bronchoalveolar lavage and endotracheal aspiration are tools that can facilitate de-escalation."

The study was supported by AstraZeneca and Bayer.

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