The usefulness of the double-light telescopic catheter in the diagnosis of bacterial pneumonia in patients under mechanical ventilation

Abstract

Fifty-eight patients who presented clinical criteria of pneumonia (fever, leukocytosis, purulent tracheo-bronchial secretions, and lung infiltrate of recent appearance in X-ray) were prospectively studied in order to determine the cost effectiveness [correction of rentability] of quantitative culture of bronchial secretions by means of a telescopic catheter (TC) in the diagnosis of bacterial pneumonia in patients under mechanical ventilation. In 25 patients (43%) a positive culture was obtained above 10(3) UFC/ml, confirming the pneumonia diagnosis in 17 cases and detecting a false positive result in one patient. In no case with a count less than 10(3) UFC/ml pneumonia diagnosis could be confirmed, being this diagnosis excluded in 24 of 33 patients with a count lower than 10(3) UFC/ml. These results suggest that the presence of fever, purulent tracheobronchial secretions and lung infiltrate in an intubated patient under mechanical ventilation does not indicate the presence of pneumonia in a high percentage of cases and that CT scan can identify those patients who require antimicrobial treatment, and this avoiding its use in patients who do not need it, with the resulting decrease in morbidity and high cost.