Accuracy of tracheal aspirate gram stain in predicting Staphylococcus aureus infection in ventilator-associated pneumonia.
Accuracy of tracheal aspirate gram stain in predicting Staphylococcus aureus infection in ventilator-associated pneumonia.
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DOI：
10.1186/1471-2253-15-19
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发表时间：
2015
影响因子：
2.2
通讯作者：
Dos Santos RP
中科院分区：
文献类型：
--
作者：
Seligman R;Seligman BG;Konkewicz L;Dos Santos RP
革兰氏染色可用于指导初始经验性抗菌治疗时，完全培养不可用。这种快速检测可以防止开始不适当的治疗和不良后果。然而，一些研究试图确定革兰氏染色在诊断和治疗不同人群呼吸机相关性肺炎（VAP）患者细菌感染中的价值，结果相互矛盾。本研究的目的是评估革兰氏染色法在预测疑似VAP患者培养物中是否存在金黄色葡萄球菌感染方面的准确性。这项前瞻性单中心开放队列研究从2005年12月至2010年12月招募了399例患者。根据ATS IDSA标准怀疑患有VAP的患者包括在内。通过气管抽吸物（TA）收集呼吸道分泌物样本，通过革兰氏染色和培养进行标准细菌镜分析。对392例患者的呼吸道分泌物进行革兰染色和培养。当革兰阳性球菌呈簇状排列时，预测培养物中金黄色葡萄球菌存在的敏感性为68.4%，特异性为97.8%，阳性预测值为88.1%，阴性预测值为92.8%（p < 0.001）。气管抽吸物革兰氏染色可用于排除临床诊断为VAP的患者中金黄色葡萄球菌的存在，阴性预测值为92.8%。因此，7.2%的金黄色葡萄球菌患者不会受到经验性治疗的保护，仅当确定簇中的革兰氏阳性球菌时，才将抗菌剂覆盖范围限制在金黄色葡萄球菌。
The Gram stain can be used to direct initial empiric antimicrobial therapy when complete culture is not available. This rapid test could prevent the initiation of inappropriate therapy and adverse outcomes. However, several studies have attempted to determine the value of the Gram stain in the diagnosis and therapy of bacterial infection in different populations of patients with ventilator-associated pneumonia (VAP) with conflicting results. The objective of this study is to evaluate the accuracy of the Gram stain in predicting the existence of Staphylococcus aureus infections from cultures of patients suspected of having VAP. This prospective single-center open cohort study enrolled 399 patients from December 2005 to December 2010. Patients suspected of having VAP by ATS IDSA criteria were included. Respiratory secretion samples were collected by tracheal aspirate (TA) for standard bacterioscopic analysis by Gram stain and culture. Respiratory secretion samples collected by tracheal aspirates of 392 patients were analyzed by Gram stain and culture. When Gram-positive cocci were arranged in clusters, the sensitivity was 68.4%, specificity 97.8%, positive predictive value 88.1% and negative predictive value 92.8% for predicting the presence of Staphylococcus aureus in culture (p < 0.001). A tracheal aspirate Gram stain can be used to rule out the presence of Staphylococcus aureus in patients with a clinical diagnosis of VAP with a 92.8% Negative Predictive Value. Therefore, 7.2% of patients with Staphylococcus aureus would not be protected by an empiric treatment that limits antimicrobial coverage to Staphylococcus aureus only when Gram positive cocci in clusters are identified.
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DOI：
10.1097/00005373-199801000-00012
发表时间：
1998-01-01
影响因子：
--
作者：
Namias, N;Harvill, S;Civetta, J
通讯作者：
Civetta, J
影响因子：
6.9
作者：
Tetenta, Sodienye;Metersky, Mark L.
通讯作者：
Metersky, Mark L.
影响因子：
9.6
作者：
Kollef, MH;Ward, S
通讯作者：
Ward, S
DOI：
10.1164/ajrccm.156.1.9607030
发表时间：
1997-07-01
影响因子：
24.7
作者：
Rello, J;Gallego, M;Valles, J
通讯作者：
Valles, J
DOI：
10.1164/ajrccm.150.6.7952612
发表时间：
1994-12-01
影响因子：
24.7
作者：
RELLO, J;TORRES, A;RODRIGUEZROISIN, R
通讯作者：
RODRIGUEZROISIN, R