Intube pneumonia patients followed in Necmettin ErbakanUniversity chest diseases intensive care unit comparison ofcultures and grams staining of bronchoalveolar lavage andtracheal aspirate materials in patients

Aim. Pneumonia is a major cause of morbidity and mortality and affects millions of people worldwide each year. Detection of the microbiological factor causing pneumonia is very important in terms of giving appropriate antibiotics and reducing the morbidity and mortality rate. In our study, we aimed to compare the endotracheal aspirate method and the bronchoscopic bronchoalveolar lavage method to detect the microbiological agent in patients followed up for ventilator-associated pneumonia (VAP). Material and Methods. This study was carried out prospectively between March 1, 2022 and February 1, 2023, with a group of patients with a diagnosis of VAP hospitalized in the chest diseases intensive care unit of Necmettin Erbakan University Meram Faculty of Medicine. In our study, bronchoalveolar lavage was performed simultaneously with endotracheal aspiration in 31 patients who were thought to have ventilator-associated pneumonia, by examining their anamnesis, physical examination findings, intensive care follow-ups, radiology and laboratory tests, and clinical pulmonary infection score, and the samples were sent to the clinical microbiology laboratory as soon as possible. . Gram stains, ARB, fungal and tuberculosis cultures, bacteriological quantitative cultures and antibiograms of the samples were examined and recorded in the microbiology laboratory. Demographic data of the patients, pre- sampling antibiotic information, APACHE II, SAPS II, SOFA, PSI scores, and 30- to 90- day mortality data were recorded. The data obtained as a result of the research were analyzed in computer environment with the SPSS (Statistical Package for Social Sciences) 18.0 package program. Results. Of the 31 patients examined, 29 patients who met the inclusion and exclusion criteria were included in the study. Twenty (69.00%) of the patients included 8 in the study were male, 9 (31.00%) were female, and the mean age was 68.24 ± 17.32 years. The most common comorbidities in these patients were hypertension with 37.90%, chronic obstructive pulmonary disease (COPD) with 27.60% and diabetes mellitus with 24.10%. The mean SAPS II score of the patients was 55.66 ± 18.30, the APACHE II score was 24.62 ± 7.09, the SOFA score was 7.14 ± 2.85, the PSI score was 144.14 ± 36.71. The 30-day mortality rate was 20.70%, and the 90-day mortality rate was 72.40%. Radiologically, pneumonia localization was evaluated bilaterally in 41.40%, right lung in 41.40%, and left lung in 17.20%. BAL culture growth was found to be significant in 8 (44.40%) patients with insignificant growth according to ETA culture, and a statistically significant difference was found in the distribution of ETA and BAL culture significant-insignificant growth rates (p=0.003). Conclusion. In our study, it was found that the bronchoscopic BAL method was superior to endotracheal aspiration in detecting the pneumonia agent. Despite the advantages of the ETA method such as being non-invasive, less costly and not providing special expertise, there are disadvantages such as contamination with oropharyngeal flora and the inability to detect the causative microorganism. We think that determining the causative agent with bronchoscopic BAL and administering appropriate antibiotic therapy in patients followed up in the ICU for VAP will contribute to reducing mortality and morbidity. Keywords. Bronchoalveolar lavage, endotracheal aspiration, vip, intensive care