Positive bronchoalveolar lavage and quantitative cultures results in suspected late-onset ventilator associated pneumonia evaluation - retrospective study [Resultados positivos do lavado broncoalveolar e culturas quantitativas na suspeita da pneumonia tardia associada ao ventilador - estudo retrospectivo]

Introduction: bronchoalveolar lavage (bal) with quantitative cultures has been used in order to increase ventilator associated pneumonia (vap) diagnosis specificity,although the accurate technique for this entity diagnosis remains controversial. objectives: to evaluate the infl uence of using positive bal and quantitative cultures results in microbiologic diagnosis and treatment of patients with suspected late vap and prior antibiotherapy. material and methods: retrospective analysis of intensive care unit (uci) patients,during a one year period,with clinical suspicion of late vap and prior use of antibiotics that presented a growth in bal cultures. results: of 243 bal performed,there were 71 (29.2 %) positive cultures (60 patients,76.7 % male,54 ± 19 years). bal was done after 13 days (median) of invasive mechanical ventilation,11 days of icu antibiotherapy and in the day in which a new antibiotic for vap suspicion was started. colony forming units (cfu)/ml count was performed in 71.8 % and endotracheal aspirate (eta) simultaneously collected for qualitative analysis in 85.9 %. therapeutic approach was changed in 38.0 %: correction (16.9 %),de-escalation (12.7 %) and directed antibiotherapy start (8.4 %). therapeutic changes were made in the presence of cfu > 104 in 84.2 % and in agreement with eta in 70.8 %. in cases in which antibiotherapy was maintained (62.0 %),quantitative cultures would have allowed de-escalation in 9.1 %. changes in prescription were more frequent when cfu was > 104 (48.5 %),comparing with situations in which counts were lower and bal analysis was only qualitative (28.9 %),p = 0.091. there were no significant differences between patients submitted to different therapeutic approaches concerning to icu mortality or length of stay. conclusion: in late onset vap,positive bal and quantitative cultures allowed therapeutic changes,leading to antibiotic adequacy and consumption reduction,which can however be maximised. © 2010 published by elsevier españa,s.l. on behalf of sociedade portuguesa de pneumologia. all rights reserved.