Sweat conductivity for diagnosing cystic fibrosis after positive newborn screening: prospective, diagnostic test accuracy study.

OBJECTIVE: To assess the accuracy of sweat conductivity among newborns and very young infants. DESIGN: Prospective, population-based, diagnostic test accuracy study. SETTING: Public Statewide Newborn Screening Programme where the incidence rate of cystic fibrosis (CF) is ≈1:11 000. PATIENTS: Newborns and very young infants with positive two-tiered immunoreactive trypsinogen. INTERVENTIONS: Sweat conductivity and sweat chloride were performed simultaneously, on the same day and facility by independent technicians, with the cut-off values of 80 mmol/L and 60 mmol/L, respectively. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive values (PPV and NPV), overall accuracy, positive and negative likelihood ratios (+LR, -LR) and post (sweat conductivity (SC)) test probability were calculated to assess SC performance. RESULTS: 1193 participants were included, 68 with and 1108 without CF, and 17 with intermediate values. The mean (SD) age was 48 (19.2) days, ranging from 15 to 90 days. SC yielded sensitivity of 98.5% (95% CI 95.7 to 100), specificity of 99.9% (95% CI 99.7 to 100), PPV of 98.5% (95% CI 95.7 to 100) and NPV of 99.9% (95% CI 99.7 to 100), overall accuracy of 99.8% (95% CI 99.6 to 100), +LR of 1091.7 (95% CI 153.8 to 7744.9) and -LR of 0.01 (95% CI 0.00 to 0.10). After a positive and negative sweat conductivity result, the patient's probability of CF increases around 350 times and drops to virtually zero, respectively. CONCLUSION: Sweat conductivity had excellent accuracy in ruling in or ruling out CF after positive two-tiered immunoreactive trypsinogen among newborns and very young infants.

Comparison between Enzyme Immunoassays Performed on Samples of Dried Blood and Serum for Toxoplasmosis Prenatal Screening: Population-based Study.

OBJECTIVE: Most prenatal screening programs for toxoplasmosis use immunoassays in serum samples of pregnant women. Few studies assess the accuracy of screening tests in dried blood spots, which are of easy collection, storage, and transportation. The goals of the present study are to determine the performance and evaluate the agreement between an immunoassay of dried blood spots and a reference test in the serum of pregnant women from a population-based prenatal screening program for toxoplasmosis in Brazil. METHODS: A cross-sectional study was performed to compare the immunoassays Imunoscreen Toxoplasmose IgM and Imunoscreen Toxoplasmose IgG (Mbiolog Diagnósticos, Ltda., Contagem, Minas Gerais, Brazil)in dried blood spots with the enzyme-linked fluorescent assay (ELFA, BioMérieux S.A., Lyon, France) reference standard in the serum of pregnant women from Minas Gerais Congenital Toxoplasmosis Control Program. RESULTS: The dried blood spot test was able to discriminate positive and negative results of pregnant women when compared with the reference test, with an accuracy of 98.2% for immunoglobulin G (IgG), and of 95.8% for immunoglobulin M (IgM). CONCLUSION: Dried blood samples are easy to collect, store, and transport, and they have a good performance, making this a promising method for prenatal toxoplasmosis screening programs in countries with continental dimensions, limited resources, and a high prevalence of toxoplasmosis, as is the case of Brazil.

OBJETIVO: A maioria dos programas de triagem pré-natal para toxoplasmose utiliza imunoensaios em amostras de soro de gestantes. Poucos estudos avaliam a acurácia dos testes de triagem em amostras de sangue seco, que são de fácil coleta, armazenamento e transporte. Este estudo teve como objetivo determinar o desempenho e avaliar a concordância entre um imunoensaio em sangue seco e um teste de referência em soro de gestantes de um programa de rastreamento pré-natal de base populacional para toxoplasmose no Brasil. MéTODOS: Realizou-se um estudo transversal para comparar os imunoensaios Imunoscreen Toxoplasmose IgM e Imunoscreen Toxoplasmose IgG (Mbiolog Diagnósticos, Ltda., Contagem, Minas Gerais, Brazil) em sangue seco com o padrão de referência ensaio fluorescente ligado a enzimas (enzyme-linked fluorescent assay, ELFA, BioMérieux S.A., Lion, França) no soro de gestantes do Programa de Controle de Toxoplasmose Congênita de Minas Gerais. RESULTADOS: O exame em sangue seco foi capaz de discriminar os resultados positivos e negativos das gestantes quando comparado ao teste de referência, com acurácia de 98,2% para imunoglobulina G (IgG), e de 95,8% para imunoglobulina M (IgM). CONCLUSãO: O sangue seco apresenta bom desempenho e é uma amostra de fácil coleta, armazenamento e transporte, o que o torna um método promissor para programas de triagem pré-natal de toxoplasmose em países com dimensões continentais, recursos limitados, e alta prevalência de toxoplasmose, como é o caso do Brasil.

Comparison between Enzyme Immunoassays Performed on Samples of Dried Blood and Serum for Toxoplasmosis Prenatal Screening: Population-based Study / Comparação entre ensaios imunoenzimáticos realizados em amostras de sangue seco e soro para triagem prénatal da toxoplasmose: Estudo populacional

Abstract Objective Most prenatal screening programs for toxoplasmosis use immunoassays in serum samples of pregnant women. Few studies assess the accuracy of screening tests in dried blood spots, which are of easy collection, storage, and transportation. The goals of the present study are to determine the performance and evaluate the agreement between an immunoassay of dried blood spots and a reference test in the serum of pregnant women from a population-based prenatal screening program for toxoplasmosis in Brazil. Methods A cross-sectional study was performed to compare the immunoassays Imunoscreen Toxoplasmose IgM and Imunoscreen Toxoplasmose IgG (Mbiolog Diagnósticos, Ltda., Contagem, Minas Gerais, Brazil)in dried blood spots with the enzymelinked fluorescent assay (ELFA, BioMérieux S.A., Lyon, France) reference standard in the serum of pregnant women from Minas Gerais Congenital Toxoplasmosis Control Program. Results The dried blood spot test was able to discriminate positive and negative results of pregnant women when comparedwith the reference test, with an accuracy of 98.2% for immunoglobulin G (IgG), and of 95.8% for immunoglobulin M (IgM). Conclusion Dried blood samples are easy to collect, store, and transport, and they have a good performance,making this a promisingmethod for prenatal toxoplasmosis screening programs in countries with continental dimensions, limited resources, and a high prevalence of toxoplasmosis, as is the case of Brazil.

Resumo Objetivo A maioria dos programas de triagem pré-natal para toxoplasmose utiliza imunoensaios em amostras de soro de gestantes. Poucos estudos avaliam a acurácia dos testes de triagem em amostras de sangue seco, que são de fácil coleta, armazenamento e transporte. Este estudo teve como objetivo determinar o desempenho e avaliar a concordância entre um imunoensaio em sangue seco e um teste de referência em soro de gestantes de um programa de rastreamento pré-natal de base populacional para toxoplasmose no Brasil. Métodos Realizou-se um estudo transversal para comparar os imunoensaios Imunoscreen Toxoplasmose IgM e Imunoscreen Toxoplasmose IgG (Mbiolog Diagnósticos, Ltda., Contagem, Minas Gerais, Brazil) em sangue seco com o padrão de referência ensaio fluorescente ligado a enzimas (enzyme-linked fluorescent assay, ELFA, BioMérieux S.A., Lion, França) no soro de gestantes do Programa de Controle de Toxoplasmose Congênita de Minas Gerais. Resultados O exame em sangue seco foi capaz de discriminar os resultados positivos e negativos das gestantes quando comparado ao teste de referência, com acurácia de 98,2% para imunoglobulina G (IgG), e de 95,8% para imunoglobulina M (IgM). Conclusão O sangue seco apresenta bom desempenho e é uma amostra de fácil coleta, armazenamento e transporte, o que o torna um método promissor para programas de triagem pré-natal de toxoplasmose em países com dimensões continentais, recursos limitados, e alta prevalência de toxoplasmose, como é o caso do Brasil.

Vancomycin-associated nephrotoxicity in non-critically ill patients admitted in a Brazilian public hospital: A prospective cohort study.

INTRODUCTION: Vancomycin is widely used to treat infections caused by Gram positive bacteria, mostly methicillin-resistant strains. Despite its therapeutic effectiveness, vancomycin is a nephrotoxic drug that has been associated with the occurrence of acute kidney injury (AKI). In this study, we sought to evaluate the variability of serum trough concentrations of vancomycin and to determine the incidence and risk factors of vancomycin-associated nephrotoxicity (VAN) in non-critically ill patients. METHODS: This was a prospective cohort including Brazilian public hospital inpatients from April 2017 to June 2018. The participants received intravenous vancomycin therapy for at least 48 hours for any suspected or confirmed infection by Gram positive bacteria. Demographic, clinical and laboratory data were collected. Information on vancomycin therapy and concomitant use of other nephrotoxic drugs were also recorded. Patients were followed up until discontinuation of vancomycin treatment or death, whatever occurred first. The primary outcome was the occurrence of AKI. We performed a Poisson regression to determine risk factors for AKI. RESULTS: Overall, 98 participants were included in the study. Median age was 55.9 (interquartile range [IQR] 40.6-66.8) years and 58 (59.2%) were men. Most of them showed subtherapeutic (<10mg/L) or supratherapeutic (>20mg/L) trough levels of vancomycin; 42.9% and 15.3%, respectively. A total of 19 (19.4%) patients developed AKI. Poisson regression showed that male sex (odds ratio [OR] 2.90; confidence interval [CI] 95% 1.28-6.53; p = 0.011), concomitant use of piperacillin-tazobactam (OR 4.66; CI 95% 2.26-9.58; p <0.001) and vancomycin trough levels above 20mg/mL (OR 4.21; CI 95% 1.57-11.278; p = 0.004) were independently associated with AKI. CONCLUSIONS: Our study showed that usual doses of vancomycin did not reach recommended therapeutic serum trough levels of vancomycin in non-critically ill patients. Besides that, nephrotoxicity was common in this population, being associated with male sex, concomitant use of piperacillin-tazobactam and supra-therapeutic trough serum levels of vancomycin.

Frequência de baixa adesão e fatores relacionados em idosos atendidos em ponto dos volantes, Vale do Jequitinhonha / Frequency of low adherence and related factors in older adults treated in Ponto dos Volantes, in the Jequitinhonha Valley

OBJETIVO: Avaliar a adesão ao tratamento medicamentoso e possíveis fatores associados em idosos entrevistados durante consultas realizadas em Unidades Básicas de Saúde. MÉTODO: Trata-se de um estudo transversal, de base populacional, com amostra de 57 pacientes com idade entre 60 e 99 anos, residentes do município de Ponto dos Volantes, Minas Gerais, incluindo as zonas rural e urbana. A coleta de dados se deu durante o ato da consulta médica, através de um roteiro eletrônico estruturado. A associação entre os parâmetros e o nível de adesão ao tratamento foi avaliada através do teste do χ2, com intervalo de confiança de 95%. RESULTADOS: Dos idosos entrevistados, 45 (78,9%) responderam sobre adesão ao tratamento. Desses, 11 (24,4%) foram enquadrados no grupo de baixa aderência. Dentre os parâmetros avaliados, nenhum apresentou associação estatística relevante com a classificação da adesão medicamentosa. CONCLUSÃO: O presente estudo identificou que um em cada quatro pacientes apresentava baixa adesão aos tratamentos medicamentosos. Dentre as variáveis estudadas, notadamente sexo, idade, escolaridade, número de comorbidades, número de medicações em uso e renda, não se observou relação estatisticamente significante.

OBJECTIVE: To evaluate adherence to medication treatment and possible associated factors in elderly patients interviewed during medical appointments in primary care units. METHOD: This was a cross-sectional, population-based study of 57 older patients aged 60 to 99 years living in the municipality of Ponto dos Volantes, state of Minas Gerais, including rural and urban areas. Data were collected during medical appointments, using a structured electronic script. The association between the parameters and the level of adherence to treatment was assessed using the χ2 test, with a 95% confidence interval. RESULTS: Among the elderly patients interviewed, 45 (78.9%) responded about adherence to treatment. Of these, 11 (24.4%) were included in the low adherence group. None " of the parameters evaluated showed a statistically significant association with the classification of drug adherence. CONCLUSION: The present study identified that 1 in every 4 patients had low adherence to drug treatment. Among the variables studied, notably sex, age, schooling, number of comorbidities, number of medications, and income, no statistically significant relationship was observed.

Effects of dimethylsulfoxide and pentoxifylline in the vitality of cutaneous flaps in rats.

OBJECTIVES: to verify the influence of dimethylsulfoxide and pentoxifylline on the vitality of cutaneous flaps in rats and the tissue repair process. METHODS: were studied 30 Wistar rats, submitting them to a 2cm wide by 8cm long dorsal cutaneous flap, of caudal base. We distributed the animals in three groups: Control Group (n=10) with application gauze moistened with 0.9% Saline in the flap bed for 30 seconds; Dimethylsulfoxide group (n=10), with administration of 1ml of 5% dimethylsulfoxide divided into five injections of 0.2ml in the transition of the flap segments; Pentoxifylline group (n=10), with administration of pentoxifylline 20mg/kg, diluted to 1ml and divided into five injections of 0.2ml in the transition of the flap segments. Drugs were administered intraoperatively, in a single dose and subcutaneously. We observed the skin flaps for changes in color and texture. On the 10th postoperative day, we checked the dimensions of viable and necrotic tissues, followed by excision of the specimen for histological analysis. RESULTS: the measurements of length of the viable and necrotic tissues between groups showed no differences. Histological analysis showed that the Dimethylsulfoxide group presented neovascularization, inflammatory infiltrate with leukocytes and more structured conjunctival stroma. The Pentoxifylline group showed neovascularization and inflammatory infiltrate, with moderate to intense granulation. The control group evolved with a higher rate of necrosis in the distal segment. CONCLUSION: dimethylsulfoxide and pentoxifylline influenced the vitality of the flap and the tissue repair process. However, they did not prevent necrosis macroscopically.

Effects of dimethylsulfoxide and pentoxifylline in the vitality of cutaneous flaps in rats / Efeitos do dimetilsulfóxido e da pentoxifilina na vitalidade de retalhos cutâneos em ratos

ABSTRACT Objectives: to verify the influence of dimethylsulfoxide and pentoxifylline on the vitality of cutaneous flaps in rats and the tissue repair process. Methods: were studied 30 Wistar rats, submitting them to a 2cm wide by 8cm long dorsal cutaneous flap, of caudal base. We distributed the animals in three groups: Control Group (n=10) with application gauze moistened with 0.9% Saline in the flap bed for 30 seconds; Dimethylsulfoxide group (n=10), with administration of 1ml of 5% dimethylsulfoxide divided into five injections of 0.2ml in the transition of the flap segments; Pentoxifylline group (n=10), with administration of pentoxifylline 20mg/kg, diluted to 1ml and divided into five injections of 0.2ml in the transition of the flap segments. Drugs were administered intraoperatively, in a single dose and subcutaneously. We observed the skin flaps for changes in color and texture. On the 10th postoperative day, we checked the dimensions of viable and necrotic tissues, followed by excision of the specimen for histological analysis. Results: the measurements of length of the viable and necrotic tissues between groups showed no differences. Histological analysis showed that the Dimethylsulfoxide group presented neovascularization, inflammatory infiltrate with leukocytes and more structured conjunctival stroma. The Pentoxifylline group showed neovascularization and inflammatory infiltrate, with moderate to intense granulation. The control group evolved with a higher rate of necrosis in the distal segment. Conclusion: dimethylsulfoxide and pentoxifylline influenced the vitality of the flap and the tissue repair process. However, they did not prevent necrosis macroscopically.

RESUMO Objetivos: verificar a influência do dimetilsulfóxido e da pentoxifilina na vitalidade e no processo de reparo tecidual de retalhos cutâneos em ratos. Método: foram estudados 30 ratos Wistar, nos quais foi confeccionado retalho cutâneo dorsal de 2cm de largura por 8cm de comprimento, de base caudal, e distribuídos em três grupos: Grupo Controle (n=10) com aplicação de gaze umedecida com solução salina a 0,9%, no leito do retalho, por 30 segundos; Grupo dimetilsulfóxido (n=10) com injeção de 1ml de dimetilsulfóxido a 5% divididos em cinco injeções de 0,2ml na transição dos segmentos do retalho; Grupo pentoxifilina (n=10) com injeção de 1ml pentoxifilina 20mg/kg, divididos em cinco injeções de 0,2ml na transição dos segmentos do retalho. Os fármacos foram administrados no transoperatório, em dose única e por via subcutânea. Os retalhos cutâneos foram observados quanto às alterações de cor e textura. No décimo dia de pós-operatório aferiu-se a dimensão do tecido viável e de necrose, seguido da exérese da peça para análise histológica. Resultados: a medida da dimensão de tecido viável e de necrose dos grupos não apresentou diferenças. A análise histológica mostrou que o grupo dimetilsulfóxido apresentou neovascularização, infiltrado inflamatório com leucócitos e estroma conjuntivo mais estruturado. O grupo pentoxifilina, mostrou neovascularização e infiltrado inflamatório com granulação moderada e intensa. O grupo controle evoluiu com maior índice de necrose no segmento distal. Conclusão: dimetilsulfóxido e pentoxifilina influenciaram na vitalidade do retalho e no processo de reparo tecidual. Entretanto, não evitaram a necrose macroscopicamente.

Analysis of effect isoxsuprine hydrochloride and nicotine in the Transverse Rectus Abdominis Myocutaneous flap (TRAM) in rats.

PURPOSE: To evaluate the effects of isoxsuprine and nicotine on TRAM. METHODS: Forty eight 48 Wistar rats distributed into four Groups (n=12). All rats received medication managed daily for 20 days: saline solution (SA), nicotine solution (NI), isoxsuprine solution (IS) and nicotine solution (NI) + isoxsuprine solution (IS). On day 21st the rats were submitted to the caudally based, right unipedicled TRAM flap and after 48 hours, made the macroscopic evaluation of the surface of the flap, photographic documentation and collection of material for histology. Data from macroscopic evaluation were analyzed by ANOVA and microscopic evaluation by Kruskal-Wallis test, with significance level of 5%. RESULTS: In the macroscopic evaluation of isoxsuprine Group retail presented absolute numbers: final area (p=0.001*) and viable area (p=0.006*) with the highest values; necrosis (p=0.001*) had the lowest value. Microscopic examination revealed no significant findings in the study of TRAM under the action of isoxsuprine and nicotine to the percentage of necrosis in the left and right cranial and caudal regions. CONCLUSIONS: There was significant improvement in viability of TRAM using the isoxsuprine solution alone. No influence using nicotine alone and in association with isoxsuprine.

Analysis of effect isoxsuprine hydrochloride and nicotine in the Transverse Rectus Abdominis Myocutaneous flap (TRAM) in rats

PURPOSE: To evaluate the effects of isoxsuprine and nicotine on TRAM. METHODS: Forty eight 48 Wistar rats distributed into four Groups (n=12). All rats received medication managed daily for 20 days: saline solution (SA), nicotine solution (NI), isoxsuprine solution (IS) and nicotine solution (NI) + isoxsuprine solution (IS). On day 21st the rats were submitted to the caudally based, right unipedicled TRAM flap and after 48 hours, made the macroscopic evaluation of the surface of the flap, photographic documentation and collection of material for histology. Data from macroscopic evaluation were analyzed by ANOVA and microscopic evaluation by Kruskal-Wallis test, with significance level of 5%. RESULTS: In the macroscopic evaluation of isoxsuprine Group retail presented absolute numbers: final area (p=0.001*) and viable area (p=0.006*) with the highest values; necrosis (p=0.001*) had the lowest value. Microscopic examination revealed no significant findings in the study of TRAM under the action of isoxsuprine and nicotine to the percentage of necrosis in the left and right cranial and caudal regions. CONCLUSIONS: There was significant improvement in viability of TRAM using the isoxsuprine solution alone. No influence using nicotine alone and in association with isoxsuprine. .

Revisão sistemática dos métodos sorológicos utilizados em gestantes nos programas de triagem diagnóstica pré-natal da toxoplasmose / Systematic review of serological methods used in prenatal screening of toxoplasmosis in pregnant women

Informações sobre a melhor estratégia para triagem sorológica da toxoplasmose em gestantes são escassas e poucos estudos mencionam o uso de amostras de sangue capilar. Realizou-se uma revisão sistemática para pesquisar os métodos sorológicos empregados em programas de triagem pré-natal da toxoplasmose no mundo e as características principais destes programas, com busca nas bases de dados PUBMED e LILACS. Foram selecionados artigos referentes a programas de triagem sorológica pré-natal da toxoplasmose que descrevessem a amostra (sangue capilar ou soro) e o teste sorológico utilizado. Foram encontrados 1554 trabalhos no PUBMED e 242 na LILACS, sendo 58 em duplicata. Foram analisados 47 artigos finais. Os testes sorológicos de triagem citados com maior frequência foram os imunoenzimáticos para detecção de IgG (19 ou 40,4%) e IgM (18 ou 38,3%) e, entre os testes confirmatórios, o mais utilizado foi o teste de avidez de IgG (14 ou 29,8%). Todos os estudos analisados utilizaram amostras de soro para a triagem pré-natal da toxoplasmose.

The best strategy for toxoplasmosis serological screening in pregnant women is not completely defined and few studies mention the use of capillary blood samples. A systematic review of the literature was conducted to investigate the serological methods used in prenatal screening programs of toxoplasmosis in the world and the main features of these programs, with search in PubMed and LILACS databases. We selected articles that described their serological prenatal screening programs, with mention of the sample (capillary blood or serum) and of the serological tests used. We found 1554 articles in PubMed database and 242 articles in LILACS, with 58 duplicates. 47 final articles were analyzed. The serological screening tests most frequently cited were immunoassays for the detection of IgG (19, 40.4%) and IgM (18, 38.3%) and between confirmatory tests, the most used was IgG avidity test (14, 29.8%). All analyzed studies used serum samples for toxoplasmosis prenatal screening. There is need for studies assessing and testing different samples in longitudinal studies.

Quantitative culture of endotracheal aspirate and BAL fluid samples in the management of patients with ventilator-associated pneumonia: a randomized clinical trial / Cultura quantitativa de aspirado traqueal e lavado broncoalveolar no manejo de pacientes com pneumonia associada à ventilação mecânica: um ensaio clínico randomizado

OBJECTIVE: To compare 28-day mortality rates and clinical outcomes in ICU patients with ventilator-associated pneumonia according to the diagnostic strategy used. METHODS: This was a prospective randomized clinical trial. Of the 73 patients included in the study, 36 and 37 were randomized to undergo BAL or endotracheal aspiration (EA), respectively. Antibiotic therapy was based on guidelines and was adjusted according to the results of quantitative cultures. RESULTS: The 28-day mortality rate was similar in the BAL and EA groups (25.0% and 37.8%, respectively; p = 0.353). There were no differences between the groups regarding the duration of mechanical ventilation, antibiotic therapy, secondary complications, VAP recurrence, or length of ICU and hospital stay. Initial antibiotic therapy was deemed appropriate in 28 (77.8%) and 30 (83.3%) of the patients in the BAL and EA groups, respectively (p = 0.551). The 28-day mortality rate was not associated with the appropriateness of initial therapy in the BAL and EA groups (appropriate therapy: 35.7% vs. 43.3%; p = 0.553; and inappropriate therapy: 62.5% vs. 50.0%; p = 1.000). Previous use of antibiotics did not affect the culture yield in the EA or BAL group (p = 0.130 and p = 0.484, respectively). CONCLUSIONS: In the context of this study, the management of VAP patients, based on the results of quantitative endotracheal aspirate cultures, led to similar clinical outcomes to those obtained with the results of quantitative BAL fluid cultures. .

OBJETIVO: Comparar a mortalidade em 28 dias e desfechos clínicos em pacientes com pneumonia associada à ventilação mecânica (PAVM) internados em UTI conforme a estratégia diagnóstica utilizada. MÉTODOS: Ensaio clínico randomizado prospectivo. Dos 73 pacientes incluídos no estudo, 36 e 37, respectivamente, foram randomizados para a realização de LBA ou aspiração traqueal (AT). A antibioticoterapia inicial baseou-se em diretrizes e foi ajustada de acordo com os resultados das culturas quantitativas. RESULTADOS: A taxa de mortalidade em 28 dias foi semelhante nos grupos LBA e AT (25,0% e 37,8%, respectivamente; p = 0,353). Não houve diferenças entre os grupos em relação a duração da ventilação mecânica, antibioticoterapia, complicações secundárias, recidiva de PAVM ou tempo de permanência hospitalar e na UTI. A antibioticoterapia inicial foi considerada adequada em 28 (77,8%) e 30 (83,3%) dos pacientes nos grupos LBA e AT, respectivamente (p = 0,551). A mortalidade em 28 dias não se associou com a adequação da antibioticoterapia inicial nos grupos LBA e AT (tratamento apropriado: 35,7% vs. 43,3%; p = 0,553; e tratamento inapropriado: 62,5% vs. 50,0%; p = 1,000). O uso prévio de antibióticos não interferiu no rendimento das culturas nos grupos AT e LBA (p = 0,130 e p = 0,484, respectivamente). CONCLUSÕES: No contexto deste estudo, o manejo dos pacientes com PAVM, baseado nos resultados da cultura quantitativa do aspirado traqueal, resultou em desfechos clínicos semelhantes aos obtidos com os resultados da cultura quantitativa do LBA. (Registro Brasileiro de Ensaios ...

Quantitative culture of endotracheal aspirate and BAL fluid samples in the management of patients with ventilator-associated pneumonia: a randomized clinical trial.

OBJECTIVE: To compare 28-day mortality rates and clinical outcomes in ICU patients with ventilator-associated pneumonia according to the diagnostic strategy used. METHODS: This was a prospective randomized clinical trial. Of the 73 patients included in the study, 36 and 37 were randomized to undergo BAL or endotracheal aspiration (EA), respectively. Antibiotic therapy was based on guidelines and was adjusted according to the results of quantitative cultures. RESULTS: The 28-day mortality rate was similar in the BAL and EA groups (25.0% and 37.8%, respectively; p = 0.353). There were no differences between the groups regarding the duration of mechanical ventilation, antibiotic therapy, secondary complications, VAP recurrence, or length of ICU and hospital stay. Initial antibiotic therapy was deemed appropriate in 28 (77.8%) and 30 (83.3%) of the patients in the BAL and EA groups, respectively (p = 0.551). The 28-day mortality rate was not associated with the appropriateness of initial therapy in the BAL and EA groups (appropriate therapy: 35.7% vs. 43.3%; p = 0.553; and inappropriate therapy: 62.5% vs. 50.0%; p = 1.000). Previous use of antibiotics did not affect the culture yield in the EA or BAL group (p = 0.130 and p = 0.484, respectively). CONCLUSIONS: In the context of this study, the management of VAP patients, based on the results of quantitative endotracheal aspirate cultures, led to similar clinical outcomes to those obtained with the results of quantitative BAL fluid cultures. (Brazilian Registry of Clinical Trials--ReBEC; identification number RBR-86DCDX [http://www.ensaiosclinicos.gov.br]).

OBJETIVO: Comparar a mortalidade em 28 dias e desfechos clínicos em pacientes com pneumonia associada à ventilação mecânica (PAVM) internados em UTI conforme a estratégia diagnóstica utilizada. MÉTODOS: Ensaio clínico randomizado prospectivo. Dos 73 pacientes incluídos no estudo, 36 e 37, respectivamente, foram randomizados para a realização de LBA ou aspiração traqueal (AT). A antibioticoterapia inicial baseou-se em diretrizes e foi ajustada de acordo com os resultados das culturas quantitativas. RESULTADOS: A taxa de mortalidade em 28 dias foi semelhante nos grupos LBA e AT (25,0% e 37,8%, respectivamente; p = 0,353). Não houve diferenças entre os grupos em relação a duração da ventilação mecânica, antibioticoterapia, complicações secundárias, recidiva de PAVM ou tempo de permanência hospitalar e na UTI. A antibioticoterapia inicial foi considerada adequada em 28 (77,8%) e 30 (83,3%) dos pacientes nos grupos LBA e AT, respectivamente (p = 0,551). A mortalidade em 28 dias não se associou com a adequação da antibioticoterapia inicial nos grupos LBA e AT (tratamento apropriado: 35,7% vs. 43,3%; p = 0,553; e tratamento inapropriado: 62,5% vs. 50,0%; p = 1,000). O uso prévio de antibióticos não interferiu no rendimento das culturas nos grupos AT e LBA (p = 0,130 e p = 0,484, respectivamente). CONCLUSÕES: No contexto deste estudo, o manejo dos pacientes com PAVM, baseado nos resultados da cultura quantitativa do aspirado traqueal, resultou em desfechos clínicos semelhantes aos obtidos com os resultados da cultura quantitativa do LBA. (Registro Brasileiro de Ensaios Clínicos - ReBEC; número de identificação RBR-86DCDX [http://www.ensaiosclinicos.gov.br]).