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International Journal of Current Microbiology and Applied Sciences (IJCMAS)
IJCMAS is now DOI (CrossRef) registered Research Journal. The DOIs are assigned to all published IJCMAS Articles.
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National Academy of Agricultural Sciences (NAAS)
NAAS Score: *5.38 (2019)
[Effective from January 1, 2019]
For more details click here

ICV 2017: 100.00
Index Copernicus ICI Journals Master List 2017 - IJCMAS--ICV 2017: 100.00
For more details click here

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PRINT ISSN : 2319-7692
Online ISSN : 2319-7706
Issues : 12 per year
Publisher : Excellent Publishers
Email : editorijcmas@gmail.com / submit@ijcmas.com
Editor-in-chief: Dr.M.Prakash
Index Copernicus ICV 2017: 100.00
NAAS RATING 2018: 5.38

Int.J.Curr.Microbiol.App.Sci.2016.5(5): 307-321
DOI: http://dx.doi.org/10.20546/ijcmas.2016.505.033


Spectrum of Organisms and Correlation of Gram-Smear and Quantitative Cultures of Endotracheal Aspirates and Broncho Alveolar Lavage Fluid with Clinical Criteria for the Diagnosis of Ventilator Associated Pneumonia
Sumana Prudhivi1*, Uma Sekhar2, Anupama Jyoti Kindo2 and Mallika2 
1Department of Microbiology, NRI Medical College, Chinakakani - 522503, Mangalagiri Mandal, Guntur District, Andhra Pradesh, India
2Department of Microbiology, Sri Ramachandra University, No: 1, Ramachandra Nagar,Porur, Chennai, Tamilnadu -600116, India
*Corresponding author
Abstract:

The purpose of this study was (1) To evaluate the value of Gram stained smear (GSS) and quantitative cultures ofendotracheal aspirates(QC ETA) and bronchoalveolar lavage fluid (QC BALF)  by correlating it with clinical criteria(CC)for the diagnosis of ventilator associated pneumonia (VAP).(2) To correlate GSS with QETA and QBALF cultures for the same. A prospective study was conducted over a period of one year. Respiratory samples – ETA: 53, BAL:25 and blood culture (BC):35 were collected from 53 patients admitted to medical and surgical ICU’s who were on mechanical ventilation (MV) for >48 hrs (2-10 days). All these  patients had various underlying comorbid illness and all of them were receiving antibiotics prior to the admission to ICU. A diagnosis of VAP was made on the basis of clinical, radiological and microbiological criteria. Cohen’s Kappa coefficient was used to quantify the level of agreement between the diagnostic tests. The sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) of GSS of ETA with CC was found to be 80%, 24.2%, 39%, 67%;the strength  of agreement was fair and the GSS of  BALF with CC was 41.67%, 23%, 33%, 30%; the strength of agreement was just by chance alone. From this we conclude that taking GSS study (ETA & BALF) alone into consideration is not a reliable indicator for the diagnosis of VAP. Therefore the initial management of patients with suspected VAP could be based on carefully studied GSS examination correlated with clinical criteria and vise versa. The sensitivity, Specificity, PPV and NPV of QETA cultures with clinical criteria was 90%, 21.2%, 40%, 77.8% respectively; the strength of agreement is considered to be fair and that of BALF cultures with CC were 58%, 23%, 41%, 37.5%; the strength of agreement was considered to be moderate. QETA cultures have shown greater sensitivity and NPV. Hence they are best interpreted by taking clinical criteria into consideration as well. QBALF cultures have shown low sensitivity and specificity; but a moderate strength of agreement when compared with clinical criteria. Greater sensitivity and specificity could probably have been obtained if the samples were collected from the lower bronchoscope segments. We conclude that when it is not feasible to do BAL, QETA cultures correlated with CC can reliabely be taken into consideration for the diagnosis of VAP. The sensitivity, specificity, PPV and NPV of GSS with QETA cultures was 86%, 66.67%, 92.6%, 50%, and that of QBALF cultures were 76.5%, 75%, 86.7% and 60%. The strength of agreement was moderate with cultures. Since GSS study of both cultures have considerably shown high sensitivity and specificity, the initial management of patients with suspected VAP could be based on GSS examination.


Keywords: Clinical criteria, Gram-smear, QETA,QBALF,VAP.
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How to cite this article:

Sumana Prudhivi, Uma Sekhar, Anupama Jyoti Kindo, Mallika. 2016. Spectrum of Organisms and Correlation of Gram-Smear and Quantitative Cultures of Endotracheal Aspirates and Broncho Alveolar Lavage Fluid with Clinical Criteria for the Diagnosis of Ventilator Associated PneumoniaInt.J.Curr.Microbiol.App.Sci. 5(5): 307-321. doi: http://dx.doi.org/10.20546/ijcmas.2016.505.033