Nigar DİRİCAN, Şöhret AYDEMİR, Feza BACAKOĞLU, Özen BAŞOĞLU KAÇMAZ, Alev GÜRGÜN, Pervin EKREN KORKMAZ, Abdullah SAYINER, Deniz NART

Ventilatörle ilişkili pnömoni tanısında endotrakeal aspiratın değeri

Giriş: Ventilatörle ilişkili pnömoni (VİP), yoğun bakım ünitesi (YBÜ)'nde invaziv mekanik ventilasyon (İMV) uygulanan olgularda en önemli mortalite nedenlerinden birisidir. Klinik ve radyolojik bulgular tanıda çoğunlukla yetersiz kaldığından, mikrobiyolojik incelemelere gereksinim duyulmaktadır.Materyal ve Metod: Çalışmamıza; solunum yetmezliği nedeniyle İMV uygulanan ve izlemde Klinik Pulmoner İnfeksiyon Skoru (CPIS) ≥ 6 bulunarak VİP nedeniyle eksitus olduğu düşünülen 24 olgu alınmıştır. Bu olguların 6'sı, postmortem biyopsi yapılamadığı için çalışma dışı bırakılmıştır. Pre-mortem CPIS ≥ 6 olup, post-mortem akciğer biyopsisi kültüründe üreme saptanan ve/veya post-mortem akciğer biyopsisi patoloji sonucu “pnömoni” ile uyumlu bulunan olgulara VİP tanısı konulmuştur. Post-mortem akciğer biyopsisi yapılan 18 olguda; pre-mortem 48 saat içinde alınan endotrakeal aspirat kantitatif kültür sonuçları, post-mortem biyopsi örneklerinin mikrobiyolojik ve histopatolojik sonuçlarıyla karşılaştırılmış ve endotrakeal aspiratın VİP tanısındaki yeri retrospektif olarak değerlendirilmiştir.Bulgular: Çalışmaya alınan 18 olgunun (12 erkek, yaş ortalaması 67.0 ± 13.0) 11 (%61.1)'i VİP tanısı almıştır. VİP tanısı konulan 11 olgunun 9 (%81.8)'unda endotrakeal aspirat kantitatif kültüründe üreme olmuştur. Endotrakeal aspirat kültür pozitifliğinin VİP tanısı koymadaki duyarlılık, özgüllük, pozitif ve negatif prediktif değerleri sırasıyla %81.8, %14.3, %60.0 ve %33.3 bulunmuştur.Sonuç: Endotrakeal aspirat kantitatif kültürünün, yoğun bakımda invaziv ventilasyon uygulanan ve CPIS ≥ 6 bulunan olgularda VİP tanısı koymak için kullanılabilecek, pratik ve güvenilir bir yöntem olduğu gösterilmiştir.

The role of endotracheal aspiration in the diagnosis of ventilator associated pneumonia

Introduction: Ventilator associated pneumonia (VAP) is one of the most important causes of mortality in patients treated with invasive mechanical ventilation (IMV) in intensive care unit (ICU). Microbiological examinations are required as clinical and radiological findings are usually insufficient in the diagnosis.Materials and Methods: Twenty four patients who were receiving IMV because of respiratory failure, had a Clinical Pulmonary Infection Score (CPIS) of ≥ 6 in the follow-up and died with the suspicion of VAP were enrolled in our study. Six patients were excluded as post-mortem biopsy could not be performed. The patients who had pre-mortem CPIS ≥ 6, in whom a causative organism was identified from the culture of post-mortem lung biopsy and/or histopathological examination of lung biopsy was compatible with pneumonia were diagnosed as VAP. In the 18 patients in whom a post-mortem lung biopsy was performed, quantitative culture results of endotracheal aspirate performed 48 hours prior to death were compared with microbiological and histopathological results of post-mortem lung biopsy specimens, and the role of endotracheal aspirate in the diagnosis of VAP was evaluated retrospectively.Results: Out of 18 patients (12 men, mean age 67.0 ± 13.0 years) included in the study, 11 (61.1%) were diagnosed as VAP. The quantitative culture of endotracheal aspirate was positive in 9 (81.8%) out of 11 patients diagnosed as VAP. The sensitivity, specificity, positive and negative predictive values of endotracheal aspirate culture for identifying VAP were found to be 81.8%, 14.3%, 60.0% and 33.3%, respectively.Conclusion: Our study shown that quantitative culture of endotracheal aspirate is a practical and reliable method that can be used for the diagnosis of VAP in patients receiving IMV in ICU and having CPIS ≥ 6.

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