Table 2 Studies comparing index test to a microbiological reference standard
References | Study population | Index test | Reference test | Results (95% confidence interval where available) | |||
|---|---|---|---|---|---|---|---|
Country | n =  | Mean age | M:F ratio | ||||
Albert et al. [57] | Canada | 705 | 58.9 | 2.9 | Gram stain of either ETA or BAL | same sample (ETA or BAL) positive culture result for pathogenic bacteria any quantity | Sens = 74% Spec = 72% κ = 0.36 (0.31–0.40) |
Anand et al. [56] | USA | 105 | 51.5 | 1.4 | sTREM-1 ELISA in BAL | BAL culture > 103 CFU/mL | Sens = 42.1% Spec = 75.6% |
Baldesi et al. [55] | France | 127 | 62.5 | 2.3 | BAL culture > 104 CFU/mL (uncorrected for dilution factor) | BAL culture > 104 CFU/mL (corrected for dilution factor using plasma/BAL urea) | Sens = 97.7% Spec = 98% |
Carvalho et al. [54] | Brazil | 22 | 59.41 |  | comparison of three sampling techniques (ETA, miniBAL, and BAL) | No mention which is considered index test or reference standard | Sens = NR Spec = NR |
Clavel et al. [51] | France | 120 | 65 | 3.1 | qPCR from BAL equivalent to > 104 CFU/mL and qPCR from ETA equivalent to > 106 CFU/mL | BAL culture > 104 CFU/mL or ETA culture > 106 CFU/mL | qPCR from BAL Sens = 89.2% Spec = 97.1% qPCR from ETA Sens = 71.8% Spec = 96.6% |
Conway Morris et al. [74] | UK | 72 | 57 | 1.5 | BAL IL-1β and IL-8 | BAL culture > 104 CFU/mL | Sens = 94% Spec = 64% |
Douglas et al. [50] | USA | 33 | 55 | N/R | Mini BAL automated microscopy | Mini BAL culture > 104 CFU/mL | Sens = 100% Spec = 97% |
Elmahalawy et al. [49] | Egypt | 40 | 45.4 | 3.0 | Pentraxin 3 ELISA in BAL | BAL culture > 104 CFU/mL | Sens = 96.7% Spec = 100% AUROCC = 0.966 (0.985 to 1) |
Fujitani et al. [47] | USA | 256 | 57.5 | 2.1 | ETA culture | Mini BAL culture > 104 CFU/mL | Sens = 65.4% Spec = 56.1% κ = 0.22 (0.17–0.27) |
Gedik et al. [46] | Turkey | 31 | 56 | 1.4 | ETA culture > 105 CFU/mL | Mini BAL culture > 104 CFU/mL | κ = 0.804, p = 0.005 |
Goldberg et al. [45] | USA | 229 | 49 | 2.0 | Gram stain of BAL | BAL culture > 105 CFU/mL | Sens = 90% Spec = 67% |
Guler et al. [43] | Turkey | 50 | 52 | 2.1 | Modified CPIS | BAL culture > 104 CFU/mL | CPIS > 7 Sens = 80% Spec = 17% CPIS > 6 Sens = 76% Spec = 15% CPIS ≥ 6 Sens = 80.7% Spec = 16.6% CPIS ≥ 5 Sens = 80% Spec = 10% |
Hashimoto et al. [42] | Japan | 51 | 41 | 1.4 | Semi-quantitative Gram stain or culture of ETA or BAL (not otherwise specified) | ETA culture > 106 CFU/mL | Gram stain Sens = 95% Spec = 61% κ = 0.59 (0.45–0.72) Culture Sens = 96% Spec = 40% κ = 0.4 (0.25–0.54) |
Hellyer et al. [41] | UK | 150 | 56.3 | 2.9 | BAL IL-1β and IL-8 | BAL culture > 104 CFU/mL | Sens = 100% Spec = 44.3% |
Jackson et al. [40] | USA | 73 | 52 | 3.5 | BAL—unilateral | BAL—bilateral | Sens = 73% Spec = 82% |
Jiao et al. [65] | China | 92 | 48 | 1.0 | Serum PCT Serum IL-6 Serum CRP | BAL culture > 104 CFU/mL | PCT Sens = 91% Spec = 71% IL-6 Sens = 58% Spec = 64% CRP Sens = 52% Spec = 74% |
Jung et al. [63] | France | 57 | 61 | 2.2 | BAL Procalcitonin | BAL culture > 104 CFU/mL | Sens = 94% Spec = 75% |
Kneidinger et al. [60] | Austria | 132 | 62 | 2.1 | BAL culture > 104 CFU/mL after 24 h storage at 4 °C and after storage at − 80 °C | BAL culture > 104 CFU/mL after immediate culture | Immediate culture vs delayed culture (4 °C) Sens = 96.5% Spec = 100% Immediate culture vs delayed culture (− 80 °C) Sens = 50.4% Spec = 100% |
Kwon et al. [59] | Korea | 64 | 65 | 2.6 | qPCR of BAL fluid or bronchial washings | BAL culture > 104 CFU/mL or bronchial washing > 105 CFU/mL | Sens = 88.9% Spec = 88.9% |
Leo et al. [58] | Mexico | 21 | 42 | 2.0 | mini BAL (using cut NG tube) > 104 CFU/mL | BAL culture > 104 CFU/mL | Sens = 92.8% Spec = 85% |
Linssen et al. [67] | USA | 117 | N/R | N/R | BAL PCT and CRP | BAL culture > 104 CFU/mL or > 2% cells with intracellular organisms | PCT AUCROCC = 0.448 CRP AUCROCC = 0.477 |
Linssen et al. [75] | USA | 282 | 60.3 | 2.1 | Various BAL cytological parameters including total cell count, alveolar macrophages, lymphocytes, neutrophils, eosinophils, mast cells, infected cells; in isolation or in combination | BAL culture > 104 CFU/mL | AUROCC for various cytological parameters Total cell count = 0.647 Alveolar macrophages = 0.313 Lymphocytes = 0.381 Neutrophils = 0.705 Eosinophils = 0.589 Mast cells = 0.557 Infected cells (%) = 0.904 AUROCC for combinations of cytological parameters Infected cells (%) + PMNs (%) = 0.892 Infected cells (%) + Total cell count = 0.890 |
Luna et al. [69] | Argentina | 283 | 71.3 | 1.1 | ETA culture > 103 CFU/mL | BAL culture > 104 CFU/mL | Sens = NR Spec = NR |
Luyt et al. [70] | France | 41 | 60 | 2.4 | serum PCT 1st day of clinical suspicion of VAP | BAL culture > 104 CFU/mL | Sens = 72% Spec = 24% |
Mongodi et al. [73] | France | 99 | 66 | 3.7 | Vplus-Eagram (ventilator-associated pneumonia lung ultrasound score and gram stain of ETA) | BAL culture > 104 CFU/mL | Sens = 81% Spec = 41% |
Oudhuis et al. [66] | Netherlands | 207 | 62 | 1.7 | ETA culture > 105 CFU/mL | BAL culture > 104 CFU/mL or > 2% cells with intracellular organisms | Sens = 65% Spec = 48% |
Refaat et al. [76] | Egypt | 66 | NR | NR | BAL composite biomarker (CRP, PCT, neutrophils, MIF, sTREM-1, suPAR) | BAL culture > 10 CFU/mL | Sens = 76% Spec = 62% |
Schnabel et al. [48] | Netherlands | 100 | 61.3 | 2.3 | VOC in exhaled breath | BAL culture > 104 CFU/mL or > 2% cells with intracellular organisms | Sens = 75.8% Spec = 73.0% |
Scholte et al. [77] | Netherlands | 311 | NR | NR | ETA Gram stain ETA Culture BALF Gram stain | BAL culture > 104 CFU/mL or > 2% cells with intracellular organisms | ETA Gram stain Sens = 65% Spec = 72% ETA Culture (any threshold) Sens = 82% Spec = 42% BALF Gram stain (> 0) Sens = 82% Spec = 66% |
Vanspauwen et al. [79] | Netherlands | 196 | 58.8 | 1.7 | BAL Clara Cell protein 10 ELISA | BAL culture > 104 CFU/mL or > 2% cells with intracellular organisms | AUROCC of 0.586 (0.496–0.676) |
Yagmurdur et al. [82] | Turkey | 59 | 71 | 0.73 | ETA culture > 104 CFU/mL | BAL culture > 104 CFU/mL | Sens = 60% Spec = 39% |
Zagli et al. [83] | Italy | 221 | 56 | 2.7 | Chest Echography and Procalcitonin Pulmonary Infection Score > 5 | ETA culture > 104 CFU/mL | Sens = 80.5% Spec = 85.2% |