Value of gram stain examination of lower respiratory tract secretions for early diagnosis of nosocomial pneumonia
| Autor: | Sami Antoun, Gérard Nitenberg, François Blot, Elisabeth Chachaty, Cyrille Tancrede, Bruno Raynard |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty endocrine system diseases Suction Critical Care and Intensive Care Medicine Artificial respiration Gastroenterology Sensitivity and Specificity law.invention law Predictive Value of Tests Internal medicine medicine Pneumonia Bacterial Humans Prospective Studies Cross Infection medicine.diagnostic_test Bacteria Staining and Labeling business.industry Respiratory disease Middle Aged medicine.disease Respiration Artificial Staining Surgery Trachea Pneumonia Bronchoalveolar lavage Gram staining Predictive value of tests Phenazines Female Gentian Violet business Empiric therapy |
| Zdroj: | American journal of respiratory and critical care medicine. 162(5) |
| ISSN: | 1073-449X |
| Popis: | Except for bronchoalveolar lavage, the value of the Gram stain examination of respiratory tract samples for the diagnosis of hospital-acquired pneumonia (HAP) and their potential impact on empiric antibiotic treatment have rarely been assessed. During a 14-mo period, both plugged telescoping catheter (PTC) and endotracheal aspirate (EA) were performed when an HAP was suspected in mechanically ventilated patients. The results of Gram stain examinations and cultures and previous and subsequent antibiotic treatment were prospectively recorded. Two criteria for pneumonia were considered: (1) clinically diagnosed pneumonia, according to attending physicians, based on clinical and radiological evolution and the PTC culture results, and (2) microbiologically proven pneumonia (solely based on the result of quantitative PTC culture). Of 91 episodes of suspected HAP in 51 patients, 27 (30%) episodes were clinically diagnosed as pneumonia. When considering clinically diagnosed pneumonia, the sensitivity and specificity of Gram stain examination were similar (respectively, 89% and 62% for EA and 67% and 95% for PTC). When considering microbiologically proven pneumonia, the sensitivity and specificity of Gram stain examination were, respectively, 91% and 64% for EA and 70% and 96% for PTC. The negative predictive value of Gram stain examination of EA and the positive predictive value of Gram stain examination of PTC were high. Our results suggest that the combination of Gram stain examination of paired PTC and EA may contribute to the early diagnosis of HAP in about two-thirds of mechanically ventilated patients, and guide the empiric therapy when needed. In the remaining one-third of patients, the Gram stain examination is not helpful in predicting HAP. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|