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Indian Pediatr 2018;55: 76 |
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Endotracheal Aspirate Microscopy and Culture in Early
Prediction of Ventilator-associated Pneumonia in Neonates
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Naveen Kumar Bhardwaj 1
and Neeraj Gupta2
Department of 1Pediatrics and 2Neonatology,
AIIMS Jodhpur, Rajasthan, India.
Email: [email protected]
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We read the article by Gupta, et al. [1] with
great interest, and would like to point out few issues:
First, the authors have collected endotracheal
aspirate (ETA) for microscopy and culture in all the neonates on
mechanical ventilation, irrespective of any clinical deterioration at
the time of collecting ETA sample. Though the CDC definition of
ventilator-associated pneumonia (VAP) [2] lacks specificity in the
absence of isolation of the pathogen, the microbiological isolation or
identification of pus cells in ETA is attempted only when there is
clinical deterioration in terms of worsening gas exchange in patients on
mechanical ventilation. The same has been highlighted by CDC while
redefining possible VAP in adults [3]. Thus, the mere presence of
organism or pus cells in ETA in absence of clinical worsening reflects
colonization rather than infection [4]. Moreover, while doing any
diagnostic study, the diagnostic test should be performed on those group
of subjects in whom it will be applied in the real world clinical
setting. Therefore, ventilated neonates having any deterioration in
terms of increasing ventilator requirement should have been the ideal
subjects for checking the utility of ETA in early diagnosis of VAP
rather than enrolling both asymptomatic and symptomatic neonates.
Second, there should be an independent and blind
comparison of the diagnostic test with the gold standard while doing any
diagnostic study. This is to avoid the bias that might cause the over-or
under-interpretation of the gold standard test. The authors have not
commented anything about this comparison.
Third, the authors have instilled 0.5 mL of normal
saline in endotracheal tube for the sample yield, which is not routinely
recommended [5]. This becomes more important in light of no information
about the ethics committee approval in the given article.
References
1. Gupta MK, Mondkar J, Swami A, Hegde D, Goel S.
Endotracheal aspirate microscopy, cultures and endotracheal tube tip
cultures for early prediction of ventilator associated pneumonia in
neonates. Indian Pediatr. 2017;54:211-4.
2. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes
JM. CDC definitions for nosocomial infections, 1988. Am J Infect
Control. 1988;16:128-40.
3. Centers for Disease Control and Prevention.
Ventilator-Associated Event (VAE). Available from:
https://www.cdc.gov/nhsn/PDFs/pscManual/10-VAE_FINAL. pdf. Accessed
April 28, 2017.
4. Gil-Perotin S, Ramirez P, Marti V, Sahuquillo JM,
Gonzalez E, Calleja I, et al. Implications of endotracheal tube
biofilm in ventilator-associated pneumonia response: a state of concept.
Crit Care. 2012;16:R93.
5. Gardner DL, Shirland L. Evidence-based guideline
for suctioning the intubated neonate and infant. Neonatal Netw.
2009;28:281-302.
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