Dilution Factor of Quantitative Bacterial Cultures Obtained by Bronchoalveolar Lavage in Patients with Ventilator-Associated Bacterial Pneumonia
| Autor: | Paul G. Ambrose, Jordi Rello, Catharine C. Bulik, Michael Vicchiarelli, Lisa Mayfield, Leah N. Woosley, Robert Duncan Hite, Ronald N. Jones, Christopher M. Rubino, Krisztina Dorizas, Thomas J. Walsh, Hassan Alnuaimat, Robert K. Flamm, Danijela Djureinovic, Brooks Edward Morgan, Marin H. Kollef, Sujata M. Bhavnani, George L. Drusano, Michelle Ferrari, Ann Doyle, Cristopher Alan Mazo Torre, Alain Combes, Kenneth V. Leeper, Jean Chastre, Richard G. Wunderink, Michael L. Corrado, Evelyn J. Ellis-Grosse, Colleen Berman, Tasnova Malek, Arnold Louie, Mona Brown, Gino Girardi, Helen K. Donnelly |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Pharmacology Chemotherapy Microbiological culture Lung medicine.diagnostic_test business.industry medicine.drug_class medicine.medical_treatment 030106 microbiology Antibiotics Bacterial pneumonia Clinical Therapeutics medicine.disease 03 medical and health sciences Infectious Diseases Bronchoalveolar lavage medicine.anatomical_structure Interquartile range Immunology Medicine Pharmacology (medical) business Pathogen |
| Popis: | Ventilator-associated bacterial pneumonia (VABP) is a difficult therapeutic problem. Considerable controversy exists regarding the optimal chemotherapy for this entity. The recent guidelines of the Infectious Diseases Society of America and the American Thoracic Society recommend a 7-day therapeutic course for VABP based on the balance of no negative impact on all-cause mortality, less resistance emergence, and fewer antibiotic treatment days, counterbalanced with a higher relapse rate for patients whose pathogen is a nonfermenter. The bacterial burden causing an infection has a substantial impact on treatment outcome and resistance selection. We describe the baseline bronchoalveolar lavage (BAL) fluid burden of organisms in suspected VABP patients screened for inclusion in a clinical trial. We measured the urea concentrations in plasma and BAL fluid to provide an index of the dilution of the bacterial and drug concentrations in the lung epithelial lining fluid introduced by the BAL procedure. We were then able to calculate the true bacterial burden as the diluted colony count times the dilution factor. The median dilution factor was 28.7, with the interquartile range (IQR) being 11.9 to 53.2. Median dilution factor-corrected colony counts were 6.18 log 10 (CFU/ml) [IQR, 5.43 to 6.46 log 10 (CFU/ml)]. In a subset of patients, repeat BAL on day 5 showed a good stability of the dilution factor. We previously showed that large bacterial burdens reduce or stop bacterial killing by granulocytes. (This study has been registered at ClinicalTrials.gov under registration no. NCT01570192.) |
| Databáze: | OpenAIRE |
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