Table 4.
Studies comparing quantitative cultures using various techniques or cutoff points
| First author | Sample | Dx tests | Gold standard | Results |
| Mondi, 2005, # [31] | Trauma ICU, 39 pts | TA (104) & (105) | BAL (105) | • TA (104): sens = 95%, spec = 58%, k = 0.5339 (p < 0.0001). • TA (105): sens = 90%, spec = 68%, k = 0.6384 (p < 0.0001). |
| Brun-Buisson, 2005, ** [32] | Mixed ICU, 68 pts | TA (score ≥4+) & bPTC (103) & PTC (103) | BAL (104 or ICO > 2%) | • TA: sens = 77%, spec = 81%. • bPTC: sens = 77%, spec = 97%. • PTC: sens = 77%, spec = 94%. |
| Davis, 2005, # [42] | Trauma ICU, 155 pts | Gram (BAL) | CDC + BAL (105) | • Gram (BAL): sens = 88% (any organism). • Gram (BAL): sens = 73%, spec = 49%; PPV = 78%, NPV = 42%, accuracy = 65% (Gram-negative). • Gram (BAL): sens = 87%, spec = 59%; PPV = 68%, NPV = 83%, accuracy = 74% (Gram-positive). |
| Croce, 2004, ** [43] | Trauma ICU, 526 pts | BAL (104 & 105) | BAL (105) and ClEvol | • BAL (105): sens = 95%, spec = 10%. • BAL (104): sens = 99%, spec = 70%. |
| Miller, 2003, ** [44] | Trauma ICU, 168 pts | BAL (102 to 104) | BAL (105) | • BAL (104 and 103): increased sensitivity = 14%. • BAL (102): increased sensitivity = 16%. |
| Sirvent, 2003, ** [45] | Mixed ICU, 82 pts | ICO | Mini-BAL (103) | • ICO ≥ 2%: sens = 80%, spec = 82%. • ICO ≥ 2% better than 1, 5, 7 and 10%. |
| Wu, 2002, ** [35] | Medical ICU, 48 pts | TA (105) | PSB (103) or BAL (104) | • TA and PSB: sens = 91%, spec = 72%; PPV = 75%, NPV = 90%. • TA and BAL: sens = 91%, spec = 75%; PPV = 78%, NPV = 90%. |
| Duflo, 2001, ** [46] | Mixed ICU, 104 pts | Gram stain (mini-BAL) | Mini-BAL (103) | • Gram stain: sens = 76%, spec = 100%, k = 0.73, concordance = 86%. |
| Prekates, 1998,*, ** [47] | BAL | • Gram stain: sens = 77%, spec = 87%, PPV = 71%, NPV = 90%. | ||
| Bello, 1996, *, ** [48] | ICU, 74 pts, consecutive | Mini-PSB | PSB and BAL | • BAL and PSB: concordance = 92%. • mini-PSB and BAL: concordance = 84%. • mini-PSB and PSB: concordance = 85%. |
| Pugin, 1991, ** [16] | Surgical ICU, 28 pts, | CPIS & mini-BAL (BI ≥ 5) | BAL (BI ≥ 5) | • CPIS: sens = 93%, spec = 100%, r = 84% (CIPS and mini-BAL), r = 76% (CPIS and BAL). • Mini-BAL: sens = 73%, spec = 96%. |
| Jourdain, 1995, ** [36] | Mixed ICU, 39 pts | TA (103 to 107) | PSB (103) and ICO (≥ 5%) | • TA (103): sens = 90%, spec = 26%, accuracy = 47%. • TA (104): sens = 84%, spec = 40, accuracy = 54%. • TA (105): sens = 79%, spec = 66%, accuracy = 70%. • TA (106): sens = 68%, spec = 84%, accuracy = 79%, correlation = 40% (TA and PSB). • TA (107): sens = 21%, spec = 92%, accuracy = 68%. |
| Marik, 1995, ** [37] | Medical ICU, 53 pts | Mini-PSB (103) | PSB (103) | • Mini-PSB and PSB: quantitative agreement = 85%. |
| Kollef, 1995, # [38] | Medical ICU, 42 pts | Mini-BAL (103) & PSB (103) | Johanson (ATS) | • Mini-BAL: sens = 100%, spec = 95%. • PSB: sens = 71%, spec = 100%. Good agreement between mini-BAL and PSB cultures: k = 0,63, concordance = 83%. |
| Rumbak, 1994, # [39] | Mixed ICU, 38 pts | TA | PSB (103) | • TA: sens = 97%, spec = 50%, PPV = 91%, NPV = 80%. |
| Valles, 1994, ** [49] | Mixed ICU, 42 pts | ICO & BAL | Clinical criteria + PSB (103) | • BAL (103): sens = 89%, spec = 79%, PPV = 76%, NPV = 90%. • BAL (104): sens = 89%, spec = 100%, PPV = 100%, NPV = 92%. • ICO (≥ 2%): = 78%, spec = 88%, PPV = 82%, NPV = 84%. • ICO (≥ 5%): = 67%, spec = 96%, PPV = 92%, NPV = 79%. • ICO (≥ 7%): = 67%, spec = 100%, PPV = 100, NPV = 80%. • ICO for Pseudomonas: lower sens. • Previous antibiotic treatment decreased sens. |
| El-Ebiary, 1993, ** [40] | Medical ICU, 102 pts | TA, PSB and BAL | Clinical ad hoc | • TA (105): sens = 70%, spec = 72%, accuracy = 71%. • PSB (103): sens = 60%, spec = 93, accuracy = 64%. • BAL (104): sens = 57%, spec = 87%, accuracy = 67%. |
| Elatrous, 2004, ** [33] | Medical ICU, 100 pts, | TA (102 to 106) | PTC (106) | • TA (102): sens = 96%, spec = 66%. • TA (103): sens = 94%, spec = 66%. • TA (104): sens = 92%, spec = 85%, k = 0,78. • TA (105): sens = 84%, spec = 90%. • TA (106): sens = 44%, spec = 94%. |
| Mimoz, 2000, ** [50] | Mixed ICU, 134 pts, | Gram stain (10 and 50 fields) | PSB (103) or bPTC (103) | • Gram (10 fields) vs PSB: sens = 74%, spec = 94%. • Gram (10 fields) vs PTC: sens = 81%, spec = 100%. • PSB: correlation between morphology and culture: sens = 54%, spec = 86%. • bPTC: correlation between morphology and culture: sens = 69% and spec = 89%. |
| Flanagan, 2000, ** [22] | Mixed ICU, 145 pts, | Mini-BAL (104) & BAL (104) & PSB (103) & CPIS & BI (≥5) | Clinical (modified CDC) | • Mini-BAL: sens = 74%, spec = 70%, PPV = 17%, NPV = 96%. • BAL: sens = 76%, spec = 71%, PPV = 35%, NPV = 93%. • PSB: sens = 68%, spec = 86%, PPV = 54%, NPV = 95%. • CPIS > 7: sens = 85%, spec = 91%, PPV = 61%, NPV = 96%. • BI: sens = 62%, spec = 53%. |
| Allaouchiche, 1999, ** [51] | Mixed ICU, 118 pts, | ICO (≥ 2%) & Gram stain (BAL) | PSB (103) | • ICO: sens = 86%, spec = 78%, PPV = 68%, NPV = 91%, k = 0.616, concordance = 81.5%. • Gram stain: sens = 90%, spec = 73%, PPV = 64%, NPV = 91%, k = 0.58, concordance = 79.4%. • Correlation between morphology and culture: complete = 51%, partial = 39.2%, no correlation = 9.8%. |
| Casetta, 1999, ** [53] | Mixed ICU (Cancer), 42 pts | PTC (103) | PSB (103) | • PTC: sens = 67%, spec = 93%; PPV = 71%, NPV = 91%, agreement = 87%. |
| Souweine, 1998, ** [54] | Mixed ICU, 52 pts | Antibiotic use & ICO (≥ 5%), PSB (103) & BAL (105) | Clin ad hoc | • ICO: sens = 71% (no antibiotics), 50% (current antibiotics), 67% (recent antibiotics). • PSB: sens = 88% (no antibiotics), 77% (current antibiotics), 40% (recent antibiotics). • BAL: sens = 71% (no antibiotics), 83% (current antibiotics), 38% (recent antibiotics). |
| Allaouchiche, 1996, ** [52] | Mixed ICU, 132 pts | ICO | PSB (103) + clinical evolution | • ICO (≥ 2%): sens = 84%, spec = 80%, PPV = 69%, NPV = 90%, ROC = 0.888. |
| Barreiro, 1996, ** [55] | Mixed ICU, 93 pts | pBAL (104) & Gram stain & ICO (≥ 2%) | PSB (103) + Follow-up | • pBAL: sens = 87%, spec = 91%, PPV = 87%, NPV = 91%. • ICO: sens = 75%, spec = 98%, PPV = 96%, NPV = 86%. |
| Torres, 1989, ** [41] | Mixed ICU, 34 pts | BAL & BI | PTC & BI | • BAL: spec = 71%, r = 0,72 (between BAL and BI) • PTC: spec = 86%, r = 0.78 (between PTC and BI) |
| Timsit, 1993, ** [56] | Mixed ICU, 26 pts | PSB 1 | PSB 2 (2 minutes interval) | • PSB 1: sens = 67%, spec = 94%. • PSB 2: sens = 54%, spec = 94%. |
| Gerbeaux, 1998, ** [57] | Mixed ICU, 44 pts | BAL 1 | BAL 2 (30 minutes interval) | • BAL 1-BAL2 repeatability = 75% with no bias, agreement = 47%. |
| Butler, 2004, ** [58] | Surgical ICU, 34 pts | Blind PSB | Directed PSB | • Blind PSB and Directed PSB: concordance = 53%. |
| Wood, 2003, ** [34] | Trauma ICU, 90 pts | TA & BDPB & BPB & BAL | BDPB & BAL | • TA & BAL: k = 0.535. • BPB & BDPB: k = 0.467. • BPB & BAL: k = 0.547. |
ICU = intensive care unit; TA = tracheal aspiration; BAL = bronchoalveolar lavage; sens = sensitivity; spec = specificity; bPTC = blinded protected telescoping catheter; PTC = protected (plugged) telescoping catheter; ICO = intracellular organism; CDC = center for disease control; PPV = positive predictive value; NPV = negative predictive value; ClEvol: clinical evolution; PSB = protected specimen brush; CPIS = clinical pulmonary infection score; BI = bacterial index; ATS = American Toracic Society; vs = versus; BDPB = bronchoscope-directed protected brushings; BPB = blind protected brushing via endotracheal tube; *retrospective; **consecutive; #convenient.