Pneumonia, ventilator-associated (VAP): Difference between revisions
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*Organism identified from pleural fluid (see [[#VAP Pathogen exclusion list]]) | *Organism identified from pleural fluid (see [[#VAP Pathogen exclusion list]]) | ||
*Virus, Bordetella, Legionella, Chlamydia or Mycoplasma identified from respiratory secretions or tissue by a culture or non-culture based microbiologic testing method | *Virus, Bordetella, Legionella, Chlamydia or Mycoplasma identified from respiratory secretions or tissue by a culture or non-culture based microbiologic testing method | ||
*In a compromised patient: identification of matching Candida from blood and sputum, endotracheal aspirate, BAL or protected specimen brushing. '''(This is a new CDC item)''' | *In a compromised patient: identification of matching Candida from blood and sputum, endotracheal aspirate, bronchoalveolar lavage (BAL) or protected specimen brushing. '''(This is a new CDC item)''' | ||
*In a compromised patient: Evidence of fungi (i.e. mycelia, not yeast) from BAL or protected specimen brushing)'''(This is a new CDC item)'''. Be aware that fungi is not the same as yeast (do not use candida spp). https://www.cdc.gov/fungal/diseases/index.html | *In a compromised patient: Evidence of fungi (i.e. mycelia, not yeast) from BAL or protected specimen brushing)'''(This is a new CDC item)'''. Be aware that fungi is not the same as yeast (do not use candida spp). https://www.cdc.gov/fungal/diseases/index.html | ||
*Positive quantitative culture, performed according to accepted protocols, from | *Positive '''quantitative culture''', performed according to accepted protocols, from BAL or protected brush specimens (see[[#VAP Pathogen exclusion list]]) | ||
** | ** According to Dr. Garland this very rare and he has never seen one done at HSC. Most bronchoscopies are not "quantitative" therefore not valid for use in the VAP criteria unless candida is cultured in immunocompromised patients only and only if the patient also has a matching blood culture. {{Discussion}} if there has to also be a blood culture then this whole comment is kind of moot, no? Ttenbergen 19:35, 2018 October 1 (CDT) | ||
*>5% of cells obtained from | *>5% of cells obtained from BAL contain intracellular bacteria on direct microscopic exam | ||
*Positive culture of lung tissue (see [[#VAP Pathogen exclusion list]]) | *Positive culture of lung tissue (see [[#VAP Pathogen exclusion list]]) | ||
*Histopathologic exam of lung tissue identifies abscess formation, or foci of consolidation with intense PMN accumulation in bronchioles and alveoli | *Histopathologic exam of lung tissue identifies abscess formation, or foci of consolidation with intense PMN accumulation in bronchioles and alveoli | ||