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Studies comparing quantitative cultures using various techniques or cutoff points |
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| First author |
Sample |
Dx tests |
Gold standard |
Results |
|
|
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| Mondi, 2005, # [31] |
Trauma ICU, 39 pts |
TA (104) & (105) |
BAL (105) |
• TA (104): sens = 95%, spec = 58%, k = 0.5339 (p < 0.0001). • TA (105): sens = 90%, spec = 68%, k = 0.6384 (p < 0.0001). |
| Brun-Buisson, 2005, ** [32] |
Mixed ICU, 68 pts |
TA (score ≥4+) & bPTC (103) & PTC (103) |
BAL (104 or ICO > 2%) |
• TA: sens = 77%, spec = 81%. • bPTC: sens = 77%, spec = 97%. • PTC: sens = 77%, spec = 94%. |
| Davis, 2005, # [42] |
Trauma ICU, 155 pts |
Gram (BAL) |
CDC + BAL (105) |
• Gram (BAL): sens = 88% (any organism). • Gram (BAL): sens = 73%, spec = 49%; PPV = 78%, NPV = 42%, accuracy = 65% (Gram-negative). • Gram (BAL): sens = 87%, spec = 59%; PPV = 68%, NPV = 83%, accuracy = 74% (Gram-positive). |
| Croce, 2004, ** [43] |
Trauma ICU, 526 pts |
BAL (104 & 105) |
BAL (105) and ClEvol |
• BAL (105): sens = 95%, spec = 10%. • BAL (104): sens = 99%, spec = 70%. |
| Miller, 2003, ** [44] |
Trauma ICU, 168 pts |
BAL (102 to 104) |
BAL (105) |
• BAL (104 and 103): increased sensitivity = 14%. • BAL (102): increased sensitivity = 16%. |
| Sirvent, 2003, ** [45] |
Mixed ICU, 82 pts |
ICO |
Mini-BAL (103) |
• ICO ≥ 2%: sens = 80%, spec = 82%. • ICO ≥ 2% better than 1, 5, 7 and 10%. |
| Wu, 2002, ** [35] |
Medical ICU, 48 pts |
TA (105) |
PSB (103) or BAL (104) |
• TA and PSB: sens = 91%, spec = 72%; PPV = 75%, NPV = 90%. • TA and BAL: sens = 91%, spec = 75%; PPV = 78%, NPV = 90%. |
| Duflo, 2001, ** [46] |
Mixed ICU, 104 pts |
Gram stain (mini-BAL) |
Mini-BAL (103) |
• Gram stain: sens = 76%, spec = 100%, k = 0.73, concordance = 86%. |
| Prekates, 1998,*, ** [47] |
BAL |
• Gram stain: sens = 77%, spec = 87%, PPV = 71%, NPV = 90%. |
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| Bello, 1996, *, ** [48] |
ICU, 74 pts, consecutive |
Mini-PSB |
PSB and BAL |
• BAL and PSB: concordance = 92%. • mini-PSB and BAL: concordance = 84%. • mini-PSB and PSB: concordance = 85%. |
| Pugin, 1991, ** [16] |
Surgical ICU, 28 pts, |
CPIS & mini-BAL (BI ≥ 5) |
BAL (BI ≥ 5) |
• CPIS: sens = 93%, spec = 100%, r = 84% (CIPS and mini-BAL), r = 76% (CPIS and BAL). • Mini-BAL: sens = 73%, spec = 96%. |
| Jourdain, 1995, ** [36] |
Mixed ICU, 39 pts |
TA (103 to 107) |
PSB (103) and ICO (≥ 5%) |
• TA (103): sens = 90%, spec = 26%, accuracy = 47%. • TA (104): sens = 84%, spec = 40, accuracy = 54%. • TA (105): sens = 79%, spec = 66%, accuracy = 70%. • TA (106): sens = 68%, spec = 84%, accuracy = 79%, correlation = 40% (TA and PSB). • TA (107): sens = 21%, spec = 92%, accuracy = 68%. |
| Marik, 1995, ** [37] |
Medical ICU, 53 pts |
Mini-PSB (103) |
PSB (103) |
• Mini-PSB and PSB: quantitative agreement = 85%. |
| Kollef, 1995, # [38] |
Medical ICU, 42 pts |
Mini-BAL (103) & PSB (103) |
Johanson (ATS) |
• Mini-BAL: sens = 100%, spec = 95%. • PSB: sens = 71%, spec = 100%. Good agreement between mini-BAL and PSB cultures: k = 0,63, concordance = 83%. |
| Rumbak, 1994, # [39] |
Mixed ICU, 38 pts |
TA |
PSB (103) |
• TA: sens = 97%, spec = 50%, PPV = 91%, NPV = 80%. |
| Valles, 1994, ** [49] |
Mixed ICU, 42 pts |
ICO & BAL |
Clinical criteria + PSB (103) |
• BAL (103): sens = 89%, spec = 79%, PPV = 76%, NPV = 90%. • BAL (104): sens = 89%, spec = 100%, PPV = 100%, NPV = 92%. • ICO (≥ 2%): = 78%, spec = 88%, PPV = 82%, NPV = 84%. • ICO (≥ 5%): = 67%, spec = 96%, PPV = 92%, NPV = 79%. • ICO (≥ 7%): = 67%, spec = 100%, PPV = 100, NPV = 80%. • ICO for Pseudomonas: lower sens. • Previous antibiotic treatment decreased sens. |
| El-Ebiary, 1993, ** [40] |
Medical ICU, 102 pts |
TA, PSB and BAL |
Clinical ad hoc |
• TA (105): sens = 70%, spec = 72%, accuracy = 71%. • PSB (103): sens = 60%, spec = 93, accuracy = 64%. • BAL (104): sens = 57%, spec = 87%, accuracy = 67%. |
| Elatrous, 2004, ** [33] |
Medical ICU, 100 pts, |
TA (102 to 106) |
PTC (106) |
• TA (102): sens = 96%, spec = 66%. • TA (103): sens = 94%, spec = 66%. • TA (104): sens = 92%, spec = 85%, k = 0,78. • TA (105): sens = 84%, spec = 90%. • TA (106): sens = 44%, spec = 94%. |
| Mimoz, 2000, ** [50] |
Mixed ICU, 134 pts, |
Gram stain (10 and 50 fields) |
PSB (103) or bPTC (103) |
• Gram (10 fields) vs PSB: sens = 74%, spec = 94%. • Gram (10 fields) vs PTC: sens = 81%, spec = 100%. • PSB: correlation between morphology and culture: sens = 54%, spec = 86%. • bPTC: correlation between morphology and culture: sens = 69% and spec = 89%. |
| Flanagan, 2000, ** [22] |
Mixed ICU, 145 pts, |
Mini-BAL (104) & BAL (104) & PSB (103) & CPIS & BI (≥5) |
Clinical (modified CDC) |
• Mini-BAL: sens = 74%, spec = 70%, PPV = 17%, NPV = 96%. • BAL: sens = 76%, spec = 71%, PPV = 35%, NPV = 93%. • PSB: sens = 68%, spec = 86%, PPV = 54%, NPV = 95%. • CPIS > 7: sens = 85%, spec = 91%, PPV = 61%, NPV = 96%. • BI: sens = 62%, spec = 53%. |
| Allaouchiche, 1999, ** [51] |
Mixed ICU, 118 pts, |
ICO (≥ 2%) & Gram stain (BAL) |
PSB (103) |
• ICO: sens = 86%, spec = 78%, PPV = 68%, NPV = 91%, k = 0.616, concordance = 81.5%. • Gram stain: sens = 90%, spec = 73%, PPV = 64%, NPV = 91%, k = 0.58, concordance = 79.4%. • Correlation between morphology and culture: complete = 51%, partial = 39.2%, no correlation = 9.8%. |
| Casetta, 1999, ** [53] |
Mixed ICU (Cancer), 42 pts |
PTC (103) |
PSB (103) |
• PTC: sens = 67%, spec = 93%; PPV = 71%, NPV = 91%, agreement = 87%. |
| Souweine, 1998, ** [54] |
Mixed ICU, 52 pts |
Antibiotic use & ICO (≥ 5%), PSB (103) & BAL (105) |
Clin ad hoc |
• ICO: sens = 71% (no antibiotics), 50% (current antibiotics), 67% (recent antibiotics). • PSB: sens = 88% (no antibiotics), 77% (current antibiotics), 40% (recent antibiotics). • BAL: sens = 71% (no antibiotics), 83% (current antibiotics), 38% (recent antibiotics). |
| Allaouchiche, 1996, ** [52] |
Mixed ICU, 132 pts |
ICO |
PSB (103) + clinical evolution |
• ICO (≥ 2%): sens = 84%, spec = 80%, PPV = 69%, NPV = 90%, ROC = 0.888. |
| Barreiro, 1996, ** [55] |
Mixed ICU, 93 pts |
pBAL (104) & Gram stain & ICO (≥ 2%) |
PSB (103) + Follow-up |
• pBAL: sens = 87%, spec = 91%, PPV = 87%, NPV = 91%. • ICO: sens = 75%, spec = 98%, PPV = 96%, NPV = 86%. |
| Torres, 1989, ** [41] |
Mixed ICU, 34 pts |
BAL & BI |
PTC & BI |
• BAL: spec = 71%, r = 0,72 (between BAL and BI) • PTC: spec = 86%, r = 0.78 (between PTC and BI) |
| Timsit, 1993, ** [56] |
Mixed ICU, 26 pts |
PSB 1 |
PSB 2 (2 minutes interval) |
• PSB 1: sens = 67%, spec = 94%. • PSB 2: sens = 54%, spec = 94%. |
| Gerbeaux, 1998, ** [57] |
Mixed ICU, 44 pts |
BAL 1 |
BAL 2 (30 minutes interval) |
• BAL 1-BAL2 repeatability = 75% with no bias, agreement = 47%. |
| Butler, 2004, ** [58] |
Surgical ICU, 34 pts |
Blind PSB |
Directed PSB |
• Blind PSB and Directed PSB: concordance = 53%. |
| Wood, 2003, ** [34] |
Trauma ICU, 90 pts |
TA & BDPB & BPB & BAL |
BDPB & BAL |
• TA & BAL: k = 0.535. • BPB & BDPB: k = 0.467. • BPB & BAL: k = 0.547. |
|
ICU = intensive care unit; TA = tracheal aspiration; BAL = bronchoalveolar lavage; sens = sensitivity; spec = specificity; bPTC = blinded protected telescoping catheter; PTC = protected (plugged) telescoping catheter; ICO = intracellular organism; CDC = center for disease control; PPV = positive predictive value; NPV = negative predictive value; ClEvol: clinical evolution; PSB = protected specimen brush; CPIS = clinical pulmonary infection score; BI = bacterial index; ATS = American Toracic Society; vs = versus; BDPB = bronchoscope-directed protected brushings; BPB = blind protected brushing via endotracheal tube; *retrospective; **consecutive; #convenient. | ||||
Rea-Neto et al. Critical Care 2008 12:R56 doi:10.1186/cc6877 |
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