• Am. J. Respir. Crit. Care Med. · Oct 1996

    The accuracy of elevated concentrations of endotoxin in bronchoalveolar lavage fluid for the rapid diagnosis of gram-negative pneumonia.

    • M H Kollef, P R Eisenberg, M F Ohlendorf, and M R Wick.
    • Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
    • Am. J. Respir. Crit. Care Med. 1996 Oct 1; 154 (4 Pt 1): 1020-8.

    AbstractThe purpose of this study was to determine the accuracy of elevated concentrations of endotoxin in bronchoalveolar lavage (BAL) fluid for the diagnosis of gram-negative pneumonia. Sixty-three hospitalized adults underwent 71 evaluations with BAL using quantitative cultures for suspected lung infection. A cutoff value of > 5 EU/ml for the concentration of endotoxin in BAL fluid yielded the best operating characteristics for the diagnosis of gram-negative pneumonia (sensitivity, 100%; specificity, 75.0%; area under receiver operating characteristic [ROC] curve, 0.88). Good diagnostic agreement was found between elevated concentrations of endotoxin in BAL fluid and microbiologically confirmed gram-negative pneumonia (kappa statistic, 0.64; concordance 83.1%). Gram stain examination of BAL fluid for the presence of gram-negative bacteria yielded inferior operating characteristics (sensitivity, 63.2%; specificity, 75.0%; area under ROC curve, 0.69). Poor diagnostic agreement was observed between BAL fluid Gram stain results and microbiologically confirmed gram-negative pneumonia (kappa statistic, 0.35; concordance, 71.8%). These findings suggest that a concentration of endotoxin in BAL fluid > 5 EU/ml is superior to Gram stain examination for the rapid identification of patients with gram-negative pneumonia.

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