CONSISTENCY BETWEEN BRONCHOALVEOLAR LAVAGE AND ENDOTRACHEAL ASPIRATE IN THE DIAGNOSIS OF VENTILATOR-ASSOCIATED PNEUMONIA

Volume 12 , Issue 4 , December 2022 , Pages 331-338

Authors

Kamaran Omer Amin 1 ; Bnar J. Hama Amin 2 ; Haval Othman 2 ; Safeen Othman Mahmood 2 ; Nsar Jamal Abdalla 2 ; Kosar Mohamed Ali 1

1 College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.

2 Shar Teaching Hospital, Sulaimani City, Kurdistan Region, Iraq.

DOI logo 10.17656/jsmc.10376

Keywords

Abstract

Background
Ventilator-associated pneumonia (VAP) is a common nosocomial lung infection. Quick and accurate
identification of the causative pathogen is crucial to improve prognosis. To date, the literature is controversial
regarding whether endotracheal aspirate (ETA) can be used as an alternative to bronchoalveolar lavage (BAL)
in VAP diagnosis.
Objectives
To evaluate the consistency between the results of BAL and ETA in the diagnosis of early- and late VAP and
to determine the microbial profiles of the involved microorganisms and their antimicrobial susceptibility.
Patients and Methods
This is a single-centre prospective study that included 50 VAP-suspected patients conducted at Shar Hospital,
Sulaimani, Iraq, from July 2021 to February 2022. The patients were categorised into early VAP and late VAP.
For each patient, both ETA and BAL techniques were used to obtain samples for microbiological analysis and
antimicrobial susceptibility testing.
Results
Ten (20%) patients developed early VAP, and 40 (80%) developed late VAP. The culture results of samples
obtained by BAL showed microbial growth in 45 (90%) of the cases. Meanwhile, ETA resulted in microbial
growth in 40 (80%) patients. In 45 (90%) of the samples, both techniques yielded the same results regarding
microbial growth in the cultures. Among the 45 samples with the same growth results, 35 (70%) showed
the same type of microbes, and 5 (10%) showed no microbial growth, indicating substantial agreement. In
both BAL and ETA, Pseudomonas aeruginosa, Staphylococcus aureus, and Acinetobacter baumannii were
the most frequently isolated pathogens. Both early- and late-VAP were associated with a high frequency
of multidrug-resistant microorganisms, 6 (75%) and 25 (56.8%), respectively. However, extensively drugresistant/pan-drug-resistant isolates were much more common in late-VAP patients (12, 27.3%).
Conclusion
ETA can be a reliable, non-invasive alternative to BAL in VAP diagnosis associated with rapid and relatively
accurate results.

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