EVALUATION OF BRONCHOSCOPIC TECHNIQUES FOR THE DIAGNOSIS OF NOSOCOMIAL PNEUMONIA
EVALUATION OF BRONCHOSCOPIC TECHNIQUES FOR THE DIAGNOSIS OF NOSOCOMIAL PNEUMONIA
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DOI：
10.1164/ajrccm.152.1.7599829
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发表时间：
1995-07-01
影响因子：
24.7
通讯作者：
GIBERT, C
中科院分区：
文献类型：
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作者：
CHASTRE, J;FAGON, JY;GIBERT, C
为了比较通过支气管肺泡灌洗（BAL）和使用受保护的标本刷（PSB）获得的标本在医院获得性肺炎诊断中的有用性，在一系列20例在疾病终末期之前未发生肺炎且近期未改变抗菌治疗的通气患者中，在死亡后立即通过纤维支气管镜进行两种程序。这些结果进行了比较，在同一地区的组织学和微生物死后肺功能。肺段细菌总数与肺段组织学分级密切相关（p = 0.79，p < 0.0001）。PSB和BAL定量培养结果与肺组织值密切相关（分别为p = 0.67和0.75; p < 0.0001）。分别使用大于或等于10（3）和大于或等于10（4）个细菌/g的判别值来定义阳性PSB和BAL培养物，这些技术鉴定了产生大于或等于10（4）个细菌/g组织的肺节段，灵敏度分别为82和91%，特异性分别为89和78%。此外，在直接观察时，含有胞内细菌的BAL细胞的百分比与从相应的肺样品获得的细菌总数密切相关（p < 0.001）。这些结果表明，支气管镜P58和BAL样本非常可靠地定性和定量鉴定细菌性肺炎肺段中存在的微生物，即使在已经接受抗菌治疗数天的患者中感染发展为双重感染时也是如此。
To compare the usefulness of specimens obtained by bronchoalveolar lavage (BAL) and using a protected specimen brush (PSB) in the diagnosis of nosocomial pneumonia, both procedures were performed via fiberoptic bronchoscopy just after death in a series of 20 ventilated patients who had not developed pneumonia before the terminal phase of their disease and who had no recent changes in antimicrobial therapy. These results were compared with both histologic and microbiologic postmortem lung features in the same area. The total number of bacteria obtained by culture of lung segments and the latters' histologic grade were closely correlated (p = 0.79, p < 0.0001). PSB and BAL quantitative culture results were strongly correlated with lung tissue values (p = 0.67 and 0.75, respectively; p < 0.0001). Using discriminative values of greater than or equal to 10(3) and greater than or equal to 10(4) bacteria/g to define positive PSB and BAL cultures, respectively, these techniques identified lung segments yielding greater than or equal to 10(4) bacteria/g tissue with sensitivities of 82 and 91% and specificities of 89 and 78%, respectively. Moreover, upon direct observation, the percentage of BAL cells containing intracellular bacteria was closely correlated with the total number of bacteria obtained from corresponding lung samples (p < 0.001). These findings indicate that bronchoscopic P58 and BAL samples very reliably identify both qualitatively and quantitatively microorganisms present in lung segments with bacterial pneumonia, even when the infection develops as a superinfection in a patient already receiving antimicrobial treatment for several days.