{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:56:40Z","timestamp":1790751400208,"version":"4.1.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[1998,7,1]],"date-time":"1998-07-01T00:00:00Z","timestamp":899251200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1998,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>We investigated the influence of pulmonary bacteriology and histology on the yield of diagnostic procedures in a clinically relevant model of ventilator-acquired pneumonia (VAP). Twenty-seven piglets entered a 4-d protocol of ventilatory support under general anesthesia. Endotracheal aspirates (EA), protected specimen brush (PSB), and bronchoalveolar lavage (BAL) were obtained on Day 4. PSB and BAL were performed under bronchoscopic guidance in dependent and nondependent lung segments. Immediately thereafter sternotomy allowed bilateral lung biopsies including the segments studied by bronchoscopic techniques. All respiratory specimens were then processed for microscopic examination and quantitative cultures (QC). In this model where many of the confounding factors often present in human studies were absent, we found that (1) although the local bacterial burden tended to correlate with the presence and the severity of histologic lesions, no definite bacteriologic cutoff could differentiate the histologic presence or absence of pneumonia; (2) histologic lesions of pneumonia and parenchymal bacterial burden were unevenly distributed through the lungs; (3) this heterogeneity in bacterial distribution also held true for single bacterial species; (4) using discriminative values of \u2265 103 cfu\/ml, \u2265 104 cfu\/ml, and \u2265 105 cfu\/ml to define positive PSB, BAL, and EA cultures, respectively, these techniques identified the histologic presence of pneumonia with a sensitivity of 69%, 78%, and 100%, respectively; (5) the specificity of these techniques in recognizing VAP was less than 50%; (6\u2009) with these discriminative values, less than 50% of PSB and BAL specimens correctly identified the causative organisms, whereas 94% of EA specimens correctly established the microbiologic diagnosis of pneumonia. We believe that the peculiar histologic and bacteriologic features of VAP may account for the difficulties of PSB and BAL, which combine QC with the use of discriminative thresholds, to reliably recognize pneumonia and to identify the causative organisms. For clinical practice, no technique confidently helps in recognizing pneumonia in mechanically ventilated patients. With regard to bacterial diagnosis, use of quantitative cultures of EA seems to be the best technique to identify the causative organisms in patients suffering VAP.<\/jats:p>","DOI":"10.1164\/ajrccm.158.1.9710061","type":"journal-article","created":{"date-parts":[[2013,4,4]],"date-time":"2013-04-04T13:37:08Z","timestamp":1365082628000},"page":"139-147","source":"Crossref","is-referenced-by-count":59,"title":["Influence of Pulmonary Bacteriology and Histology on the Yield of Diagnostic Procedures in Ventilator-Acquired Pneumonia"],"prefix":"10.1093","volume":"158","author":[{"given":"DELPHINE","family":"WERMERT","sequence":"first","affiliation":[{"name":"D\u00e9partement de Pneumologie, Service d'Anatomopathologie, and Service de Bact\u00e9riologie et Hygi\u00e8ne, H\u00f4pital A. Calmette, CHRU de Lille; D\u00e9partement Hospitalo-Universitaire de Recherche Exp\u00e9rimentale, Facult\u00e9 de M\u00e9decine, Lille; and INSERM U416, Institut Pasteur, Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CHARLES-HUGO","family":"MARQUETTE","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Pneumologie, Service d'Anatomopathologie, and Service de Bact\u00e9riologie et Hygi\u00e8ne, H\u00f4pital A. Calmette, CHRU de Lille; D\u00e9partement Hospitalo-Universitaire de Recherche Exp\u00e9rimentale, Facult\u00e9 de M\u00e9decine, Lille; and INSERM U416, Institut Pasteur, Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MARIE-CHRISTINE","family":"COPIN","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Pneumologie, Service d'Anatomopathologie, and Service de Bact\u00e9riologie et Hygi\u00e8ne, H\u00f4pital A. Calmette, CHRU de Lille; D\u00e9partement Hospitalo-Universitaire de Recherche Exp\u00e9rimentale, Facult\u00e9 de M\u00e9decine, Lille; and INSERM U416, Institut Pasteur, Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"FR\u00c9D\u00c9RIC","family":"WALLET","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Pneumologie, Service d'Anatomopathologie, and Service de Bact\u00e9riologie et Hygi\u00e8ne, H\u00f4pital A. Calmette, CHRU de Lille; D\u00e9partement Hospitalo-Universitaire de Recherche Exp\u00e9rimentale, Facult\u00e9 de M\u00e9decine, Lille; and INSERM U416, Institut Pasteur, Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ANNE","family":"FRATICELLI","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Pneumologie, Service d'Anatomopathologie, and Service de Bact\u00e9riologie et Hygi\u00e8ne, H\u00f4pital A. Calmette, CHRU de Lille; D\u00e9partement Hospitalo-Universitaire de Recherche Exp\u00e9rimentale, Facult\u00e9 de M\u00e9decine, Lille; and INSERM U416, Institut Pasteur, Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"PHILIPPE","family":"RAMON","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Pneumologie, Service d'Anatomopathologie, and Service de Bact\u00e9riologie et Hygi\u00e8ne, H\u00f4pital A. Calmette, CHRU de Lille; D\u00e9partement Hospitalo-Universitaire de Recherche Exp\u00e9rimentale, Facult\u00e9 de M\u00e9decine, Lille; and INSERM U416, Institut Pasteur, Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ANDR\u00c9-BERNARD","family":"TONNEL","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Pneumologie, Service d'Anatomopathologie, and Service de Bact\u00e9riologie et Hygi\u00e8ne, H\u00f4pital A. Calmette, CHRU de Lille; D\u00e9partement Hospitalo-Universitaire de Recherche Exp\u00e9rimentale, Facult\u00e9 de M\u00e9decine, Lille; and INSERM U416, Institut Pasteur, Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[1998,7,1]]},"reference":[{"key":"2026032709021825400_B1","doi-asserted-by":"crossref","first-page":"551S","DOI":"10.1016\/S0012-3692(16)34868-1","article-title":"International consensus conference: clinical investigation of ventilator associated pneumonia.","volume":"102","author":"Meduri","year":"1992","journal-title":"Chest"},{"key":"2026032709021825400_B2","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1164\/ajrccm\/146.4.1059","article-title":"Nosocomial bronchopneumonia in the critically ill: histologic and bacteriologic aspects.","volume":"146","author":"Rouby","year":"1992","journal-title":"Am. Rev. Respir. 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