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COMPARISON OF THE ROLE OF INITIAL SURVEILLANCE CULTURES AND THE SERIAL SURVEILLANCE CULTURES IN PREDICTING THE VENTILATOR ASSOCIATED PNEUMONIA (VAP) ETIOLOGY. Gül Gürsel, Müge Aydoğdu, Türkan Nadir Öziş, Seçil Taşyürek
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COMPARISON OF THE ROLE OF INITIAL SURVEILLANCE CULTURES AND THE SERIAL SURVEILLANCE CULTURES IN PREDICTING THE VENTILATOR ASSOCIATED PNEUMONIA (VAP) ETIOLOGY Gül Gürsel, Müge Aydoğdu, Türkan Nadir Öziş, Seçil Taşyürek Gazi University Medical Faculty Pulmonary Diseases Department Intensive Care Unit
INTRODUCTION • VAP is one of the most common infections in intensive care units with very high mortality. Early diagnosis and appropriate antibiotic therapy can decrease mortality. • Broad spectrum antibiotics used emprically have the risk of increasing antibiotic resistance; whereas antibiotics started depending on the culture results have the risk of increased mortality. • Many studies are being published indicating that surveillance cultures may be helpfull in initiating appropriate antibiotic therapy by previously predicting the VAP pathogen
INTRODUCTION Surveillance cultures can be used; • To follow the yearly incidence, causative pathogens and resistance patterns of nosocomial infections. • To identify whether patients are colonized or not, when they are hospitalized • With the help of serial surveillance cultures to identify the hospital acquired pathogensthat patients are colonized with
INTRODUCTION • But the routine use of surveillance cultures are not recommended. Since; • Its evidence-based benefit can not be shown • Cost-effectivity is unknown • How, when, from where and with what frequency cultures should be obtained? All unknown. • The evidences for its contribution to initiate the appropriate antibiotic therapy and to improve survival are still lacking
AIM • To compare the diagnostic value of initial endotracheal aspirate cultures (I-ETA) with serial surveillance (SS-ETA) cultures in predicting the VAP etiology.
MATERIAL AND METHOD • A total of 92 patients receiving at least 4 days of mechanical ventilation therapy were included in the study. • ETA cultures were obtained from all patients at the day of intubation and then in every other day. • Patients were followed daily for VAP development and VAP diagnosis were made clinically and microbiologically. • I-ETA and SS-ETA cultures were compared for their predictive capability of VAP pathogens . • Sensitivity,spesificity, PPV and NPV were calculated.
RESULTS From 92 patients; • 92 I-ETA cultures • 250 SS-ETA cultures were obtained
DISCUSSION • SS-ETA cultures predicted the causative pathogen of VAP in 27% of the patients with VAP who were using antibiotics and gave negative result in 30% of patients without VAP. • In both conditions the predictive value of SS-ETA cultures for VAP pathogen were identified as superior to I-ETA cultures • But SS- ETA can give false positive result in 8% and false negative result in 35% of the patients.
Limitations of the study: • Low patient number • No cost-effectivity analysis • Not being in the study design, the effect of surveillance cultures on appropriate antibiotic therapy and survival are unknown
CONCLUSION • The value of SS-ETA is quite much higher than I-ETA in predicting the VAP etiology in patients who have been using antibiotics . • But as a whole since its specificity and sensitivity is still low, the use of SS-ETA cultures routinely can not be recommended in all intubated and mechanically ventilated patients.