Rapid Automated Microscopy for Microbiological Surveillance of Ventilator-associated Pneumonia
Rapid Automated Microscopy for Microbiological Surveillance of Ventilator-associated Pneumonia
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DOI：
10.1164/rccm.201408-1468oc
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发表时间：
2015-03-01
影响因子：
24.7
通讯作者：
Howson, David C.
中科院分区：
文献类型：
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作者：
Douglas, Ivor S.;Price, Connie S.;Howson, David C.
基本原理：呼吸机相关性肺炎（VAP）的诊断不准确。目的：（1）确定隔日监测微量支气管肺泡灌洗是否（2）评估自动显微镜检查在减少分析时间方面的潜力。方法：纳入了预计需要通气至少48小时的成人重症监护室患者。使用（1）临床培养（50 +/-7小时）和（2）自动显微镜（类似于5小时phis离线分析）对微型BALs进行鉴定、定量和抗生素敏感性处理。1例患者（3%）被临床诊断为VAP。在73个配对样本中，培养鉴定出7个含有肺炎组细菌（>10（4）菌落形成单位/ml），来自5名患者（15%）（4个金黄色葡萄球菌[3个耐甲氧西林S.金黄色葡萄球菌]，2例嗜麦芽窄食单胞菌，1例肺炎克雷伯菌），并导致5例患者中的2例（40%）发生抗菌剂变化/添加。与培养结果相比，显微镜检查确定了7/7个微生物阳性微生物和64/66个阴性样品。在五项比较中，有四项的抗菌反应是一致的。抗菌药物的变化/添加会发生在三个七个显微镜阳性患者（43%），这些结果在临床上可在5小时，包括一个病人后来诊断为VAP尽管负迷你BAL culture.Conclusions：微生物监测检测感染的风险独立于临床症状的雅普患者，导致抗菌治疗的变化。与临床培养相比，自动显微镜对高危肺炎微生物的敏感性为100%，特异性为97%。基于显微镜的快速监测可能为VAP风险患者的治疗和抗菌管理提供信息。
Rationale: Diagnosis of ventilator-associated pneumonia (VAP) is imprecise.Objectives: To (1) determine whether alternate-day surveillance mini-bronchoalveolar lavage (mini-BAL) in ventilated adults could reduce time to initiation of targeted treatment and (2) evaluate the potential for automated microscopy to reduce analysis time.Methods: Adult intensive care unit patients who were anticipated to require ventilation for at least a further 48 hours were included. Mini-BALs were processed for identification, quantitation, and antibiotic susceptibility, using (1) clinical culture (50 +/- 7 h) and (2) automated microscopy (similar to 5 h phis offline analysis).Measurements and Main Results: Seventy-seven mini-BALs were performed in 33 patients. One patient (3%) was clinically diagnosed with VAP. Of 73 paired samples, culture identified 7 containing pneumonia panel bacteria (>10(4) colony-forming units/ml) from five patients (15%) (4 Staphylococcus aureus [3 Methicillin-resistant S. aureus], 2 Stenotrophomonas maltophilia,1 Klebsiella pneumoniae) and resulted in antimicrobial changes/additions to two of five (40%) of those patients. Microscopy identified 7 of 7 microbiologically positive organisms and 64 of 66 negative samples compared with culture. Antimicrobial responses were concordant in four of five comparisons. Antimicrobial changes/additions would have occurred in three of seven microscopy-positive patients (43%) had those results been clinically available in 5 hours, including one patient diagnosed later with VAP despite negative mini-BAL cultures.Conclusions: Microbiological surveillance detected infection in patients at risk for YAP independent of clinical signs, resulting in changes to antimicrobial therapy. Automated microscopy was 100% sensitive and 97% specific for high-risk pneumonia organisms compared with clinical culturing. Rapid microscopy-based surveillance may be informative for treatment and antimicrobial stewardship in patients at risk for VAP.