Eur Respir J

Eur Respir J. polyvalent (75.6% vs. 33.8%)-p < 0.001 for any. The accuracy of the greatest cut-off points for VAP diagnosis relating to polyvalent and monoclonal ACBs was higher than 95.0% and 93.3%, respectively. Conclusions: The amounts of ACB in EA examples had been higher among situations than among handles. Our findings suggest that analyzing ACB in EA is normally a promising device to boost the specificity AT7867 2HCl of VAP medical diagnosis. The technique could possibly be cost-effective and useful in low-resource configurations as a result, with advantages of reducing false-positive outcomes and staying away from overtreatment. Keywords: Pneumonia, ventilator-associated/medical diagnosis; Immunohistochemistry; Fluorescent antibody technique; Antibodies, bacterial/evaluation; Trachea/microbiology; Intensive ELTD1 treatment systems RESUMO Objetivo: A pneumonia associada ventila??o mecanica (PAVM) o primary tipo de infec??o adquirida no ambiente hospitalar em pacientes em UTIs. O diagnstico de PAVM desafiador, principalmente devido a limita??es dos mtodos diagnsticos disponveis. O objetivo deste estudo foi determinar se a avalia??o de bactrias revestidas por anticorpos (BRA) pode melhorar a especificidade de culturas de aspirado traqueal (AT) no diagnstico de PAVM. Mtodos: Estudo diagnstico caso-controle envolvendo 45 pacientes sob ventila??o mecanica. Amostras de AT foram obtidas de pacientes com e sem PAVM (casos e controles, respectivamente), e verificamos o nmero AT7867 2HCl de bactrias revestidas com anticorpos monoclonais conjugados com FITC (IgA, IgM ou IgG) ou anticorpo polivalente conjugado com FITC. Utilizando microscopia de imunofluorescncia, foi determinada a propor??o de BRA em um nmero fixo de 80 bactrias. Resultados: A mediana das propor??es de BRA foi significativamente maior nos casos (n = 22) que nos controles (n = 23) – IgA (60,6% vs. 22,5%), IgM (42,5% vs. 12,5%), IgG (50,6% vs. 17,5%) e polivalente (75,6% vs. 33,8%) – p < 0,001 para todos. A acurcia dos melhores pontos de corte para o diagnostico de PAVM em rela??o aos BRA monoclonais e polivalentes foi > 95,0% e > 93,3%, respectivamente. Conclus?es: O nmero de BRA em amostras de AT foi maior nos casos que nos controles. Nossos achados indicam que a avalia??o de BRA no AT uma ferramenta promissora para aumentar a especificidade do diagnstico de PAVM. A tcnica pode ser custo-efetiva e, portanto, til em locais com poucos recursos, com as vantagens de minimizar resultados falso-positivos e evitar o tratamento excessivo. INTRODUCTION Ventilator-associated pneumonia (VAP) affects approximately 25% AT7867 2HCl of patients submitted to mechanical ventilation, with an incidence of 2-16 episodes/1,000 hospital admissions. 1 , 2 Although VAP is usually associated with high mortality, the attributable mortality can be low depending on the case mix and adjustments. 3 – 6 In addition, VAP contributes to multiple organ failure in debilitated patients, prolonged hospitalization and increased health-associated costs. 7 , 8 The diagnosis of VAP is usually challenging, and guidelines suggest that a clinical approach, a microbiologic approach, or both should be employed. 4 , 9 – 11 Clinical criteria alone have been shown to have low specificity, because several other pathologies seen in the ICU can mimic VAP, 11 – 13 although their high sensitivity is useful for raising the suspicion of pneumonia. 9 , 12 Conversely, clinicians cannot rely only on microbiologic results, because it can be difficult to deal with false-positives (e.g., to differentiate between tracheal colonization and contamination) 9 and false-negatives (e.g., culture-negative results due to previous antibiotic use) when interpreting a respiratory tract culture result. 4 , 6 , 9 Combining the two methods AT7867 2HCl (clinical and microbiological) seems to improve the diagnostic accuracy. 4 , 9 , 14 In medical practice, invasive and noninvasive techniques are used in order to obtain samples from the lower respiratory tract for microbiological evaluation. Recently, a clinical trial 15 and a meta-analysis both showed that there are no differences between invasive and noninvasive techniques regarding main outcomes. 16 Although invasive methods have higher specificity than does the collection of endotracheal aspirate (EA), the former are more expensive and usually require bronchoscopic guidance. 14 , 17 Worldwide, EA is used in order to diagnosis VAP and can be more cost-effective, making it especially useful in.