Table 3.
Studies comparing quantitative cultures with pathology
| First author | Sample | Dx Tests | Gold standard | Results |
| Balthazar, 2001, ** [13] | Mixed ICU, 37 pts | BAL (104) & Gram & cells from BAL | Pathology + Culture | • BAL: sens = 19%, spec = 94%; fever: sens = 50%, spec = 76%; leucocytosis (>10000): sens = 60%, spec = 76%; Gram stain: sens = 85%, spec = 94%; total cell (>400000): sens = 90%, spec = 94%. |
| Torres, 2000, ** [26] | Medical ICU, 25 pts | TBA (105) & PSB (103) & BAL (104) & pBAL (104) | Pathology + Culture | • TBA: sens = 50%, spec = 67%. • PSB: sens = 67%, spec = 75%. • pBAL: sens = 63%, spec = 83%. • BAL: sens = 83%, spec = 68%. |
| Fabregas, 1999, ** [11] | MIxed ICU, 25 pts | Johanson & CPIS & TBA (105), PSB (103), pBAL (104) and BAL (104) | Pathology + Culture | • Johanson criteria (2): sens = 69%, spec = 75%. • Any Johanson criteria: Chest Rx: sens = 92%, spec = 33%; leukocytosis: sens = 77%, spec = 58%; fever: sens = 46%, spec = 42%; purulent secretions: sens = 69%, spec = 42%. • CPIS: sens = 77%, spec = 42%. • TBA: sens = 69%, spec = 92%. • pBAL: sens = 39%, spec = 100%. • BAL: sens = 77%, spec = 58%. • PSB: sens = 62%, spec = 75%. • QtC increased little to clinical diagnosis accuracy. |
| Papazian, 1997, # [29] | Mixed ICU, 28 pts | Gram & ICO | Pathology + Culture | • BBS Gram stain: sens = 56%, spec = 73%. • mini-BAL Gram Stain: sens = 44%, spec = 87%. • BAL Gram stain: sens = 56%, spec = 100%. • BBS ICO (>10%): sens = 56%, spec = 40%. • Mini-BAL ICO (>5%): sens = 67%, spec = 53%. • BAL ICO (>4%): sens = 56%, spec = 40%. |
| Kirtland, 1997, ** [27] | Mixed ICU, 39 pts | TA &PSB & pPSB & BAL & BAL cells | Pathology + Culture | • TA: sens = 87%, spec = 31%. • pPSB: sens = 30%, spec = 81%. • PSB: sens = 44%, spec = 81%. • BAL: sens = 65%, spec = 63%. • >50% neutrophils in BAL: sens = 100%. |
| Marquette, 1995, ** [28] | Mixed ICU, 28 pts | TA (105 & 106) & PSB (103) & BAL (104) | Pathology | • TA (105): sens = 63%, spec = 75%. • TA (106): sens = 50%, spec = 85%. • PSB (103): sens = 57%, spec = 88%. • BAL (104): sens = 47%, spec = 100%. • ICO (any%): sens = 36%, spec = 100%. |
| Torres, 1996 *, ** [25] | Mixed ICU, 25 pts | ICO (≥ 5%), mini-BAL (104) & BAL (104) | Pathology | • ICO (≥ 5%) compared to mini-BAL: PPV = 75%, NPV = 83%. • ICO (≥ 5%) compared to BAL: PPV = 57%, NPV = 8 3%. • Mini-BAL: sens = 22%, spec = 100%. • BAL: sens = 45%, spec = 55%. |
| Papazian, 1995, ** [17] | MIxed ICU, 38 pts | BBS (104) & mini-BAL (103) & PSB (103) & BAL (104) & CPIS | Pathology + Culture | • CPIS: sens = 72%, spec = 85%. • BBS (104): sens = 83%, spec = 80%. • mini-BAL (103): sens = 67%, spec = 80%. • BAL (104): sens = 58%, spec = 95%. • PSB (103): sens = 42%, spec = 95%. |
| Torres, 1994, ** [24] | Mixed ICU, 30 pts | TBA (105) & PSB (103) & BAL (104) & Clinical data | Pathology | • Clinical data: fever: sens = 55%, spec = 58%; purulent secretions: sens = 83%, spec = 33%; Rx infiltrate: sens = 78%, spec = 42%. • Pulmonary biopsy culture (≥103): sens = 40%, spec = 45%. • Quantitative cultures: TBA: sens = 44%, spec = 48%; PSB: sens = 36%, spec = 50%; BAL: sens = 50%, spec = 45%. |
| Rouby, 1989, ** [30] | Surgical ICU, 59 pts | pBAL | Pathology + culture | • pBAL: sens = 80%, spec = 66% to identify VAP; sens = 73% to identify the microorganism. |
| Chastre, 1984, ** [10] | Mixed ICU, 26 pts | PSB (103) | Lung culture | • PSB correlated well to lung cultures, especially in the subgroup of patients who received no antibiotics during the week preceding their death. |
ICU = intensive care unit; BAL = bronchoalveolar lavage; sens = sensitivity; spec = specificity; TBA = tracheobronchial aspirate; PSB = protected specimen brush; pBAL = protected BAL or 'mini-BAL'; CPIS = clinical pulmonary infection score; QtC = quantitative culture; ICO = intracellular organism; BBS = blind bronchial sampling; TA = tracheal aspiration; PPV = positive predictive value; NPV = negative predictive value; * = retrospective; ** = consecutive; # convenient