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Báo cáo y học: "Qualitative cultures in ventilator-associated pneumonia – can they be used with confidence"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care cung cấp cho các bạn kiến thức về ngành y đề tài: Qualitative cultures in ventilator-associated pneumonia – can they be used with confidence? | Available online http ccforum.eom content 8 6 425 Commentary Qualitative cultures in ventilator-associated pneumonia - can they be used with confidence Carlos M Luna1 and Alejandro Chirino2 Associate Professor of Internal Medicine Pulmonary Division Hospital de Clínicas Universidad de Buenos Aires Argentina 2Fellow Pulmonary Division Hospital de Clínicas Universidad de Buenos Aires Argentina Corresponding author Carlos M Luna cymluna@giga.com.ar Published online 25 October 2004 This article is online at http ccforum.com content 8 6 425 2004 BioMed Central Ltd Related to Research by Camargo et al. see page 513 Critical Care 2004 8 425-426 DOI 10.1186 cc2988 Abstract The sensitivity and specificity of the radiographic and clinical evidence used to diagnose ventilator-associated pneumonia vary depending on the number of clinical criteria present. Bacteriological confirmation that rules out other diseases can be achieved by quantitative or qualitative cultures of tracheal aspirate. The rate of tracheal colonization in ventilated patients reduces the usefulness of qualitative cultures but the absence of multiresistant micro-organisms in cultures from patients on prior antibiotics or a sterile culture in patients without prior antimicrobials may provide sufficient justification to stop or de-escalate antibiotics. However more accurate guidance regarding whether antibiotics are unnecessary and should be stopped is provided by quantitative culture. Keywords antibacterial agents diagnostic techniques microbiology respiratory tract infections Clinically ventilator-associated pneumonia VAP is defined by the presence of new or progressive radiographic infiltrates plus clinical evidence that these infiltrates are of infectious origin. The presence of an infiltrate plus at least two out of three clinical features abnormal temperature 38 C or 36 C leucocytosis or leucopenia and purulent secretions are the most accurate criteria for starting empirical antibiotic therapy 1 . .