Diagnosis of nosocomial pneumonia in medical ward:: repeatability of the protected specimen brush
Diagnosis of nosocomial pneumonia in medical ward:: repeatability of the protected specimen brush
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DOI：
10.1183/09031936.01.99097901
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发表时间：
2001-07-01
影响因子：
24.3
通讯作者：
Chouaïd, C
中科院分区：
文献类型：
--
作者：
Herer, B;Fuhrman, C;Chouaïd, C
本研究的目的是评估在同一肺部区域连续进行的两对受保护样本刷 (PSB) 的重复性，并在床边或实验室进行处理，并描述 39 例非通气患者疑似院内肺炎的细菌学结果。将四对 PSB 分为两对。床边准备一对刷子（PB），然后送到实验室；另一对(PL)立即送往实验室进行完整处理。根据10(3)菌落形成单位(cfu).mL(-1)阈值，156个PSB中49%呈阳性。使用 10(-3) cfu.mL 阈值，PL 刷的一致性为 89.7%，而 PB 刷的一致性为 76.9%。 PL 刷的 PSB 培养物 K 值表示的重复性高于 PB 刷（K 值分别为 0.795 和 0.537，p = 0.12）。在 156 个 PSB（176 个分离株）中，分离出 58.3% 的细菌物种。在 14 例中，PSB 培养物发现超过一种微生物，浓度 > 10(3) cfu.mL(-1)。最常分离的生物体是假单胞菌属。 (23.9%)、肠杆菌科 (23.3%)、链球菌属。 (21.6%,) 和葡萄球菌属。 （13.1%）。如果患者进行了气管造口术，则多种微生物培养的频率更高（9 名进行气管造口术的患者中有 7 名进行了气管造口术，而 30 名未进行气管造口术的患者中有 7 名进行了多种微生物培养，p < 0.01）。在 31.8% 的 PL 刷患者和 56.5% 的 PB 刷患者中观察到细菌学差异，导致抗菌治疗中潜在的麻烦选择。重症监护病房外受保护的标本刷的重复性较低，这似乎依赖于采样处理。在非通气患者中怀疑院内肺炎时发现的病原体分布似乎与呼吸机相关性肺炎中发现的病原体分布相似。
The aims of this study were to assess the repeatability of two pairs of protected specimen brushes (PSB) done successively in the same lung area and either processed at the bedside or in the laboratory, and to provide a description of the bacteriological findings in 39 cases of suspected nosocomial pneumonia occurring in nonventilated patients.Four PSB were divided into two pairs. One pair of brushes (PB) was prepared at bedside and then sent to the laboratory; the other pair (PL) was immediately sent to the laboratory for complete processing.According to a 10(3) colony forming units (cfu).mL(-1) threshold, 49%, out of 156 PSB were positive. Using the 10(-3) cfu.mL threshold, the PL brushes were 89.7% concordant while the PB brushes were 76.9% concordant. The repeatability as expressed by K-value of the cultures of PSB was higher for PL brushes than for PB brushes (K-values of 0.795 and 0.537 respectively, p = 0.12). Bacterial species were isolated in 58.3% of 156 PSB (176 isolates). In 14 cases, cultures of PSB disclosed more than one micro-organism in a concentration > 10(3) cfu.mL(-1). The most frequently isolated organisms were Pseudomonas spp. (23.9%), Enterobacteriaceae (23.3%,), Streptococcus spp. (21.6%,) and Staphylococcus spp. (13.1%). Polymicrobial cultures were more frequent if the patient had a tracheostomy (seven out of the nine patients with a tracheostomy versus seven out of the 30 patients without a tracheostomy, p < 0.01). Bacteriological discrepancies leading to a potential troublesome choice in antibiotherapy were observed in 31.8% of the patients for PL brushes and 56.5%, of the patients for PB brushes.There is a low degree of repeatability of protected specimen brushes outside intensive care units which seem dependent on sampling processing. The distribution of pathogens found in case of suspicion of nosocomial pneumonia in nonventilated patients appears to be similar to that obtained in ventilator-associated pneumonia.