Study of quantitative bacterial cultures of non-bronchoscopic samples in ventilator associated pneumonia


  • Mohamed Azarudeen Department of Pediatrics, SMS Medical College, Jaipur, Rajasthan, India
  • B. S. Sharma Department of Pediatrics, SMS Medical College, Jaipur, Rajasthan, India
  • Pankaj Kumar Jain Department of Pediatrics, SMS Medical College, Jaipur, Rajasthan, India
  • Alok Kumar Goyal Department of Pediatrics, SMS Medical College, Jaipur, Rajasthan, India
  • Bharti Malhotra Department of Microbiology, SMS Medical College, Jaipur, Rajasthan, India



ETA, NB-BAL, Non-bronchoscopic sample culture, VAP


Background: Diagnosis of VAP based on non bronchoscopic samples-ETA, NB-BAL culture. The aim is to study quantitative culture of the non-bronchoscopic sampling techniques such as Blind Broncho-alveolar lavage (NB-BAL) and endotracheal aspirates (ETA)in Ventilator Associated Pneumonia. It is a hospital based, observational study conducted in SPMCHI, Jaipur from September 2015 to September 2016.

Methods: Seventy patients who were under mechanical ventilation for more than 48 hours and clinically suspected for VAP were included in the study and divided into early and late onset VAP. The NB-BAL and ETA were obtained from these patients and quantitative cultures were performed.

Results: Out of the 70 samples analysed, 60 patients were found positive in BAL and 61 positive in ETA. The agreement between NB-BAL and ETA is 86.8%. GNBs remain the main burden of both early and late onset VAP. Most common organisms isolated were Enterobacter and Acinetobacter in early onset and Pseudomonas and Acinetobacter in late onset VAP. All the GNB isolates were sensitive to Polymyxin and Colistin and were resistant to majority of routinely used antibiotics.

Conclusions: The quantitative culture of   non-bronchoscopic samples is a useful alternative to bronchoscopy, in the diagnosis of VAP in resource deprived centers. MDR gram negative bacilli are the main causative agents of VAP.



Centers for Disease Control and Prevention. Guidelines for preventions of nosocomial pneumonia. Mortal Morb Wkly Rep. 1997:1-79. Available at

Celis R, Torres A, Gatell JM, Almela M, Rodriguez-Roisin R. Nosocomial pneumonia: a multivariate analysis of risk and prognosis. Chest. 1988;93:318-24.

Centers for Disease Control and Prevention. Device associated Events/ Ventilator Associated Pneumonia (VAP) Event. 2011;6:1-14.2. Available at

Leo A, Galindo-Galindo J, Folch E, Guerrero A, Bosques F, Mercado R, et al. Comparison of bronchoscopic bronchoalveolar lavage vs blind lavage with a modified nasogastric tube in the etiologic diagnosis of ventilator-associated pneumonia. Medicina Intensiva. 2008;32(3):115-20.

Hospital-acquired pneumonia in adults: Diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement, American Thoracic Society, November 1995. Am J Respir Crit Care Med. 1996;153(5):1711-25.

Sachdev A, Chugh K, Sethi M, Gupta D, Wattal C, Menon G. Diagnosis of ventilator-associated pneumonia in children in resource-limited setting: a comparative study of bronchoscopic and nonbronchoscopic methods. Pediatr Crit Care Med. 2010;11:258-66.

Torres A, Fabregas N, Ewig S, de la Bellacasa JP, Bauer TT, Ramirez J. Sampling methods for ventilator-associated pneumonia: validation using different histologic and microbiological references. Crit Care Med. 2000;28:2799-804.

Sachdev A, Chugh A, Sethi M, Gupta N, Wattal C, Menon G. Clinical pulmonary infection score to diagnose ventilator associated pneumonia in children. Indian Pediatr. 2011;48:949-54.

Morrow BM, Futter MJ, Argent AC. Paediatric nonbronchoscopic bronchoalveolar lavage overview and recommendations for clinical practice. South African J Physiotherapy. 2006;62(1):28-33.

Pugain J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic blind bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991;143:1121-9.

Johanson WG Jr, Seidenfeld JJ, Gomez P, De Los Santos R, Coalson JJ. Bacteriologic diagnosis of nosocomial pneumonia following prolonged mechanical ventilation. Am Rev Respir Dis. 1988;137:259-64.

da Silva PS, de Aguiar VE, de Carvalho WB, Fonseca MC. Value of clinical pulmonary infection score in critically ill children as a surrogate for diagnosis of ventilator-associated pneumonia. J Critical Care. 2014;29(4):545-50.

Lodha R, Kabra SK. Diagnosis of ventilator associated pneumonia: Is there a simple solution?. Indian Pediatr. 2011;48(12):939-40.

Ratjen F, Bruch J. Adjustment of bronchoalveolar lavage volume to body weight in children. Pediatr Pulmonol. 1996;21(3):184-8.

Yildiz-Atikan B, Karapinar B, Aydemir S, Vardar F. Comparison of endotracheal aspirate and non-bronchoscopic bronchoalveolar lavage in the diagnosis of ventilator-associated pneumonia in a pediatric intensive care unit. Turkish J Pediatr. 2015;57(6):578-86 .

Artuk C, Gül HC, Mert G, Karakaş A, Bedir O, Eyigün CP. Comparison of endotracheal aspiration and mini-BAL culture results in the diagnosis of ventilator-associated pneumonia. Mikrobiyol Bul. 2012 Jul;46(3):421-31.

Ibrahim EH, Tracy L, Hill C, Fraser VJ, Kollef MH. The occurrence of ventilator-associated pneumonia in a community hospital: risk factors and clinical outcomes. Chest. 2001 Aug;120(2):555-61.

Golia S, Sangeetha KT, Vasudha CL. Microbial profile of early and late onset ventilator associated pneumonia in the intensive care unit of a tertiary care hospital in Bangalore, India. J Clinical Diagnostic Res: JCDR. 2013 Nov;7(11):2462-6.

Girish N, Rajendran R. Bacteriological Profile of Ventilator Associated Pneumonia in a Tertiary Care Hospital and their Antibiotic Resistance Pattern. Int J Med Microbiol Trop Dis. 2015;1(1):1-5.

Mohanty D, Routray SS, Mishra D, Das A. Ventilator associated pneumonia in a ICU of a tertiary care Hospital in India. J Contemp Med Res. 2016;3(4):1046-9.






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