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Values of combined detection of bronchoalveolar lavage fluid endotoxin and serum procalcitonin levels for the rapid diagnosis of early methicillinresistant Staphylococcus aureus-caused ventilator-associated pneumonia

This study investigated the usefulness of the combined detection of Bronchoalveolar Lavage Fluid (BALF) endotoxin and serum Procalcitonin (PCT) levels for the rapid diagnosis of early Methicillin- Resistant Staphylococcus aureus (MRSA)-caused Ventilator-Associated Pneumonia (VAP) in the Intensive Care Unit (ICU). BALF and venous blood samples were obtained from 69 patients, admitted to the ICU, who required invasive mechanical ventilation. PCT levels were assessed within 72 to 96 h of ICU admission regardless of the VAP status. Based on the BALF-endotoxin and serum PCT levels, the patients were divided into four groups: group A, BALF endotoxin<6 endotoxin units per mL (EU/ml) and PCT>0.5 ng/ml; group B, BALF endotoxin<6 EU/ml and PCT<0.5 ng/ml; group C, BALF endotoxin>6 EU/ml and PCT>0.5 ng/ml; group D, BALF endotoxin>6 EU/ml and PCT<0.5 ng/ml. The proportion of MRSA infection in group A was significantly higher than that in the other groups (P<0.05); when the BALF-endotoxin was<6 EU/ml and the serum PCT was>0.5 ng/ml, the sensitivity of early MRSA-VAP was 63.64%, with specificity, positive predictive value, and negative predictive value of 91.89%, 70.00%, and 89.47%, respectively. Therefore, the evaluation of BALF-endotoxin and serum PCT levels may be a fast, economical, and effective diagnostic method for the early identification of MRSA-VAP in the ICU.

Author(s): Zhijian Huang, Yiqiang Chen, Feiyu Sun, Lihua Lei, Qing Yu, Shifu Wu