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Blind-protected telescopic catheter: a simple, reliable and cost-effective method for the diagnosis of the ventilator-associated pneumonia

Abstract number: 902_p488

Koulourida V.

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Objective:

Ventilator-associated pneumonia (VAP) is a serious infection in the ICU (elevated mortality, cost of the diagnostic procedures and the antibiotics). In our hospital, broncoscopic procedures for the diagnosis of the VAP are rarely used. This study evaluated the utility and cost-effectiveness of the blind PTC in the diagnosis of the VAP in a 10-bed ICU.

Methods:

In a 2-year prospective study, PTC was performed and found positive in 57 patients with a clinical suspicion of VAP (new pulmonary infiltrate, purulent secretions, hypoxaemia, fever, leucocytosis). We compared these protected telescopic catheter (PTC) patients to 98 others (matched for age and APACHE II score) who were treated empirically for a VAP but did not have a PTC (non-PTC patients). We evaluated (i) the time needed for the quantitative culture of the PTC, (ii) the time necessary for the report of the results, (iii) the accuracy and ability of the method to safely guide a de-escalation strategy.

Results:

(i) Approximately 30 min were needed for the culture (desinfection and vortexing of the tip, dilutions, susceptibility tests according to the NCCLS); (ii) results were communicated to the ICU physicians in 48–72 h; (iii) mean age (55 ± 14 years) and APACHE II score (19 ± 8 years) were comparable between the two groups as well as the duration of antibiotics before the VAP (5.8 ± 3 days vs. 6.7 ± 4 days). Two of the 57 PTCs were contaminates (3.5%), 52 of 55 PTC patients were treated for VAP (94.5% clinical relevance, 5.5% false positives). Finally, in 22 of these 52 PTC patients, Imipenem was switched to Piperacilin/Tazobactam (42.3%). Vancomycin was withdrawn from the empirical antibiotic regimen in 20 of the 52 PTC patients (38.5%). No change was attempted in the empirical antibiotic regimen of the 98 non-PTC patients. The number of patients died was comparable in the groups (13 PTC vs. 24 non-PTC patients; P > 0.5).

Conclusions:

PTC is a simple and reliable method for the diagnosis of the VAP. Guided by the PTC, physicians can safely discontinue large-spectrum antibiotics. Any additional cost of its use can be easily waged by the discontinuation of unnecessary antibiotics.

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Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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