Utility of Tracheal Aspirate Culture in Newly Intubated Patients with Community-Onset Pneumonia.
Ann Am Thorac Soc. 2016 Jan 21;
Authors: McCauley LM, Webb BJ, Sorensen J, Dean NC
RATIONALE: Successful treatment of life-threatening community-acquired pneumonia requires appropriate empiric antibiotic coverage. Using conventional diagnostic techniques, a microbiological diagnosis is often not achieved. The diagnostic utility of tracheal aspirate at the time of intubation in patients with severe pneumonia has not been well studied.
OBJECTIVES: Evaluate the utility of tracheal aspirate culture in identifying pneumonia pathogens.
METHODS: We identified all patients ≥ 18 years old with International Classification of Disease, 9th revision: ICD-9 codes and radiographic evidence of pneumonia seen in the emergency departments at 2 university-affiliated Utah hospitals from December 2009 to November 2010 and from December 2011 to November 2012. Patients intubated within 24 hours of arrival were then identified electronically. Post-intubation orders instructed respiratory therapists to obtain tracheal aspirate for culture. All culture results were individually reviewed and defined as positive if a pneumonia pathogen was identified. Results of other microbiology studies were obtained from the electronic medical record.
MEASUREMENTS AND MAIN RESULTS: Of 2,011 patients with pneumonia, 94 were intubated and 84 had a tracheal aspirate obtained. Of these 84 patients, 47 (56%) had a pulmonary pathogen identified by tracheal aspirate culture; 80 also had blood cultures; and 71 underwent Pneumococcal and Legionella urinary antigen testing. A microbiologic diagnosis was made in 55 (65.5%) patients by any diagnostic method. In 39% (32 of 82) of patients the tracheal aspirate culture was the only positive test, resulting in a unique microbiological diagnosis in patients who would have otherwise been classified "culture negative".
CONCLUSION: Tracheal aspirate cultures obtained as part of routine care identified a plausible pneumonia pathogen in over half of emergency department adult patients with severe pneumonia requiring intubation. Tracheal aspirate culture offers important additive diagnostic value to other routine tests.
PMID: 26793950 [PubMed - as supplied by publisher]