Introduction
Materials and methods
Sampling technique
Criteria |
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I. At least three positive results of the following four criteria |
1. Rectal temperature > 38°C or < 35.5°C |
2. Blood leucocytosis (> 10 × 10³/mm³) and/or left shift of blood leucopenia (< 3 × 10³/mm³) |
3. > 10 leukocytes per high-power magnification field in Gram stain of tracheal aspirate |
4. Positive culture from tracheal aspirate |
II. New, persistent progressive infiltrate visualised on chest radiograph |
Laboratory processing
Exclusion criteria
Definition of confirmed ventilator-associated pneumonia
Collection of clinical data
Determination of CC-10 concentration in BAL fluid
Quality control of CC-10 concentration in BAL fluid
Urea concentration analysis
Statistical analyses
Results
Patients included in the study
Parameter | VAP | Non-VAP | P value |
---|---|---|---|
Number of patients | 79 | 117 | |
Mean age in years (range) | 60 (19-84) | 58 (18-87) | 0.445 |
Male:female ratio | 1.6:1 | 1.7:1 | 0.887 |
Mortality rate (%) | 44 | 36 | 0.324 |
Median hospital stay in days (range) | 47 (7-540) | 47 (6-297) | 0.289 |
Median ICU stay in days (range) | 43 (6-484) | 46 (1-291) | 0.454 |
Median days of intubation (range) | 8 (1-172) | 8 (1-198) | 0.289 |
Reason for admission, number of patients (%) | |||
Cardiac | 6 (7.6) | 12 (10.3) | |
Pulmonary | 14 (17.8) | 27 (23.1) | |
Trauma | 14 (17.8) | 15 (12.8) | |
Surgery | 17 (21.5) | 15 (12.8) | |
Neurological | 10 (12.6) | 6 (5.1) | |
Malignancy | 5 (6.3) | 9 (7.7) | |
Vascular surgery | 6 (7.6) | 19 (16.2) | |
Other | 7 (8.3) | 14 (12.0) | |
Median Clara cell protein concentration in ng/mL (range) | 3,019 (282-65,546) | 2,504 (62-30,240) | 0.03 |
Microorganism | VAP n (%) | Early-onset VAP n (%) | Late-onset VAP n (%) | Non-VAP n (%) |
---|---|---|---|---|
Pseudomonas aeruginosa
| 12 (14) | 4 (11) | 8 (20) | 11 (9) |
Staphylococcus aureus
| 11 (13) | 7 (17) | 2 (5) | |
Escherichia coli
| 5 (6) | 3 (8) | 1 (2) | 2 (2) |
Proteus spp. | 1 (1) | 1 (2) | ||
Klebsiella spp. | 7 (9) | 6 (16) | 2 (5) | |
Stenotrophomonas maltophilia
| 2 (3) | |||
Moraxella catharrhalis
| 1 (1) | 1 (3) | 2 (5) | |
Serratia spp. | 3 (4) | 1 (3) | 2 (5) | |
Enterobacter spp. | 3 (4) | 1 (3) | 2 (5) | |
Haemophilus spp. | 6 (8) | 4 (11) | ||
Mixed | 17 (21) | 7 (17) | 10 (24) | 3 (2.5) |
Other | 11 (13) | 4 (11) | 7 (17) | |
No growth | 101 (86.5) | |||
Total (n) | 79 | 38 | 41 | 117 |
Alternative diagnoses | Patients n (%) |
---|---|
Alternative pulmonary diagnosis | |
Acute respiratory distress syndrome | 25 (21) |
Congestive heart failure | 20 (17) |
Diffuse alveolar damage | 9 (8) |
Idiopathic pulmonary fibrosis | 5 (4) |
Autoimmune disease | 4 (3) |
Pulmonary contusion | 3 (2.5) |
Pulmonary oedema of unknown origin | 3 (2.5) |
Eosinophilic pneumonia | 2 (1.5) |
Pneumocystis pneumonia | 2 (1.5) |
Bronchiolitis obliterans with organizing pneumonia | 1 (1) |
Drug-induced pneumonia | 1 (1) |
Chronic obstructive pulmonary disease | 1 (1) |
Sarcoidosis | 1 (1) |
Aspergillus fumigatus infection | 1 (1) |
Legionella pneumophila infection | 1 (1) |
No diagnosis | 16 (14) |
No pulmonary disease | 22 (19) |
Total (n) | 117 |
Alternative infectious diagnosis | |
Intravenous catheter-related infection | 7 (6) |
Urosepsis | 5 (4) |
Peritonitis | 2 (1.5) |
Mediastinitis | 2 (1.5) |
Encephalitis | 1 (1) |
Abdominal abscess | 1 (1) |
No infectious focus found | 99 (85) |
Total (n) | 117 |
Spiking recovery of CC-10 in BAL fluid
CC-10 concentration in VAP group versus non-VAP group
CC-10 concentration in early- and late-onset VAP
CC-10 concentrations in the VAP subgroups versus the non-VAP group
Influence of ICU admittance indication on CC-10 concentration
Antibiotic and corticosteroid therapy at the time of BAL
Discussion
Conclusions
Key messages
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The CC-10 concentration in BAL fluid is not a useful predictive parameter for the diagnosis of VAP.
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The CC-10 concentration in BAL fluid may be an indicator for pulmonary inflammation in general.