Microbiologic surveillance through subglottic secretion cultures during invasive mechanical ventilation: a prospective observational study

Whether subglottic secretions (SS) culture during invasive mechanical ventilation may aid microbiological surveillance is unknown. We conducted a prospective study to assess SS cultures predictivity of endotracheal aspirate (ETA) and bronchoalveolar lavage (BAL) isolates. 109 patients receiving mech...

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Bibliographic Details
Published in:Journal of critical care 2020-10, Vol.59, p.42-48
Main Authors: Bello, Giuseppe, Bisanti, Alessandra, Giammatteo, Valentina, Montini, Luca, Eleuteri, Davide, Fiori, Barbara, La Sorda, Marilena, Spanu, Teresa, Grieco, Domenico L., Pennisi, Mariano A., De Pascale, Gennaro, Antonelli, Massimo
Format: Article
Language:English
Subjects:
Aged
Antimicrobial agents
Bacteria - isolation & purification
Bacterial Infections - diagnosis
Bacterial Infections - microbiology
Bodily Secretions - microbiology
Bronchoalveolar Lavage - methods
Bronchoalveolar Lavage Fluid - microbiology
Catheters
Critical care
Culture Techniques - methods
Data Accuracy
Female
Humans
Intensive care unit
Laboratories
Lavage
Male
Mechanical ventilation
Medical diagnosis
Middle Aged
Observational studies
Ostomy
Patients
Pneumonia
Pneumonia, Ventilator-Associated - diagnosis
Pneumonia, Ventilator-Associated - microbiology
Predictive Value of Tests
Prospective Studies
Respiration, Artificial - adverse effects
Respiratory system diagnostic techniques
Sensitivity and Specificity
Software
Suctioning
Surveillance
Ventilator-associated pneumonia
Ventilators
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Summary:Whether subglottic secretions (SS) culture during invasive mechanical ventilation may aid microbiological surveillance is unknown. We conducted a prospective study to assess SS cultures predictivity of endotracheal aspirate (ETA) and bronchoalveolar lavage (BAL) isolates. 109 patients receiving mechanical ventilation for ≥48 hours underwent SS and ETA surveillance cultures twice weekly; blind BAL was performed in case of clinically suspected pneumonia. SS and ETA cultures were fully concordant in 170 (81%-overall accuracy) of 211 sample pairs. As compared to ETA, SS culture global sensitivity and specificity were 84% [95%CI: 77 to 91] and 74% [95%CI: 66 to 82]; negative and positive predictive values were 82% and 77%. Forty-four episodes of clinically suspected pneumonia were observed. Compared to BAL, SS culture global sensitivity and specificity were 68% [95%CI: 45 to 81] and 63% [95%CI: 44 to 82]; negative and positive predictive values were both 65%. SS sensitivity, specificity, positive and negative predictive values in anticipating BAL isolates were comparable to ETA (all p > 0.20). SS cultures show worthy accuracy in identifying ETA isolates, with excellent sensitivity and good negative predictivity. SS cultures may be not inferior to ETA in predicting BAL results in case of ventilator-associated pneumonia. Trial registration:ClinicalTrials.gov, NCT03153241. Registered on 15 May 2017, https://clinicaltrials.gov/ct2/show/NCT03153241 •Subglottic secretion cultures can predict endotracheal aspirate pathogens.•Subglottic secretions are not inferior to endotracheal aspirate in anticipating bronchoalveolar lavage results.•Subglottic secretion cultures may be an easy tool for microbiologic surveillance.
ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2020.05.013