• Giuseppe Bello, Alessandra Bisanti, Valentina Giammatteo, Luca Montini, Davide Eleuteri, Barbara Fiori, Marilena La Sorda, Teresa Spanu, Domenico L Grieco, Mariano A Pennisi, Gennaro De Pascale, and Massimo Antonelli.
• Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Istituto di Anestesia e Rianimazione; Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: giuseppe.bello@policlinicogemelli.it.
• J Crit Care. 2020 Oct 1; 59: 42-48.

PurposeWhether subglottic secretions (SS) culture during invasive mechanical ventilation may aid microbiological surveillance is unknown. We conducted a prospective study to assess SS cultures predictivity of endotracheal aspirate (ETA) and bronchoalveolar lavage (BAL) isolates.Materials And Methods109 patients receiving mechanical ventilation for ≥48 hours underwent SS and ETA surveillance cultures twice weekly; blind BAL was performed in case of clinically suspected pneumonia.ResultsSS and ETA cultures were fully concordant in 170 (81%-overall accuracy) of 211 sample pairs. As compared to ETA, SS culture global sensitivity and specificity were 84% [95%CI: 77 to 91] and 74% [95%CI: 66 to 82]; negative and positive predictive values were 82% and 77%. Forty-four episodes of clinically suspected pneumonia were observed. Compared to BAL, SS culture global sensitivity and specificity were 68% [95%CI: 45 to 81] and 63% [95%CI: 44 to 82]; negative and positive predictive values were both 65%. SS sensitivity, specificity, positive and negative predictive values in anticipating BAL isolates were comparable to ETA (all p > 0.20).ConclusionsSS cultures show worthy accuracy in identifying ETA isolates, with excellent sensitivity and good negative predictivity. SS cultures may be not inferior to ETA in predicting BAL results in case of ventilator-associated pneumonia.Trial RegistrationClinicalTrials.gov, NCT03153241. Registered on 15 May 2017, https://clinicaltrials.gov/ct2/show/NCT03153241.Copyright © 2020 Elsevier Inc. All rights reserved.

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