Ventilator-associated pneumonia represents a serious threat to the recovery of patients with respiratory failure (50 to 70 percent mortality rate) and a difficult diagnostic challenge for. the physician in charge of their care. In intubated patients, fever and pulmonary infiltrate are frequently of nonpneumonic origin, and cultures of the tracheal aspirate (>70 percent false positive rate) have been proven unreliable. Bronchoscopy with PSB and BAL, despite its own limitations, appears to be the most effective means to establish the presence or absence of nosocomial pneumonia in ventilated patients. ampicillin antibiotic
The diagnostic value of bronchoscopy with PSB in this setting was originally established by Chastre et al in a landmark study on postmortem ventilated patients. These investigators, however, observed three important limitations: (1) a small number of false positive results, as high as 50 percent in patients receiving antimicrobials, (2) results of culture are usually unavailable for 24 to 48 h, and (3) proper catheter placement is essential to avoid false negative results, since the specimen brush samples only a limited area of the lung. Both sensitivity and specificity of quantitative bacterial cultures of the PSB have ranged, in the best situations, between 60 and 100 percent.
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