Table 6.
Studies comparing cytological examination to quantitative cultures
| First author | Sample | Dx tests | Gold standard | Results |
| 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). |
| 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%. |
| 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%. |
| Mimoz, 2000, ** [50] | Mixed ICU, 134 pts | Gram stain (10 and 50 fields) | PSB (103) or bPTC (103) | • Gram stain (10 fields) vs PSB: sens = 74%, spec = 94%. • Gram stain (10 fields) vs PTC: sens = 81%, spec = 100%. • Gram (50 fields): slight increase in spec, decrease in sens • Morphology and PSB culture: sens = 54%, spec = 86%. • Morpholgy and bPTC culture: sens = 69%, spec = 89%. |
| 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.%, no correlation: 9.8%. |
| 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. |
| 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 = 83%. • Mini-BAL: sens = 22%, spec = 100%. • BAL: sens = 45%, spec = 55%. |
| Sole-Violan, 1994, ** [68] | Mixed ICU, 33 pts | ICO (BAL) & BAL (104) & PSB (103) | Clinical ad hoc | • BAL: sens = 87%, spec = 100%. • PSB: sens = 75%, spec = 100%. • ICO (>4%): sens = 62%, spec = 100%. |
| Brasel, 2003, ** [66] | Surgical ICU, 35 pts | ICO 5% & ICO 7% | TA (104) & TA (105) | • ICO 5% and TA (104): sens = 61%, spec = 89%, PPV = 90%, NPV = 59%, ROC = 0.84. • ICO 5% and TA (105): sens = 85%, spec = 82%, PPV = 70%, NPV = 91%, ROC = 0.89. • ICO 7% and TA (104): sens = 39%, spec = 97%, PPV = 96%, NPV = 50%, ROC = 0.86. • ICO 7% and TA (105): sens = 61%, spec = 91%, PPV = 77%, NPV = 82%, ROC = 0.84. |
| Timsit, 2001, ** [65] | Mixed ICU, 110 pts | BAL-D (1% of infected cells) | BAL (104) & PSB (103) | • BAL-D: sens = 93%, spec = 91%, AUC = 0.953, PPV = 90%, NPV = 98%. |
| Prekates, 1998, ** [47] | Surgical and Trauma ICU, 75 pts, | Gram stain (BAL) | BAL | • Gram stain: sens = 77%, spec = 87%, PPV = 71%, NPV = 90%. |
ICU = intensive care unit; BAL = bronchoalveolar lavage; CDC = center of disease control; sens = sensitivity; spec = specificity; PPV = positive predictive value; NPV = negative predictive value; ICO = intracellular organism; PSB = protected specimen brush; bPTC = blinded protected telescoping catheter; vs = versus; PTC = protected (plugged) telescoping catheter; TA = tracheal aspiration; BAL-D = direct examination of BAL; *retrospective; **consecutive; #convenient.