A reappraisal of the role of Gram's stains of tracheal aspirates in guiding antibiotic selection in the surgical intensive care unit
A reappraisal of the role of Gram's stains of tracheal aspirates in guiding antibiotic selection in the surgical intensive care unit
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DOI：
10.1097/00005373-199801000-00012
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发表时间：
1998-01-01
影响因子：
--
通讯作者：
Civetta, J
中科院分区：
文献类型：
--
作者：
Namias, N;Harvill, S;Civetta, J
背景资料：气管吸出物革兰氏染色用于指导外科重症监护室（SICU）经验性肺炎治疗中的抗生素选择。我们质疑，是否革兰氏染色预测微生物培养，方法：前瞻性收集的数据进行回顾性审查。结果：在543例SICU培养物中有284例（52%）和403例创伤重症监护室（TICU）培养物中有226例（56%）革兰氏染色与培养的微生物相关，革兰氏阴性杆菌（GNR）菌株在205个SICU培养物中的182个（89%）和176个TICU培养物中的160个（91%）中产生GNR微生物，革兰氏阳性球菌（GPC）染色在228个SICU培养物中的75个（33%）和149个TICU培养物中的52个（35%）中产生GPC生物体，GPC组的非相关性主要是GNR（185/250（74%））。当临床决定有必要使用经验性抗生素时，无论革兰氏染色结果如何，都应建立GNR覆盖范围，制定GPC覆盖范围的决定需要得到临床数据的支持，而不是革兰氏染色。
Background: Tracheal aspirate Gram's stains are used to guide antibiotic selection in empiric pneumonia treatment in the surgical intensive care unit (SICU). We questioned,whether Gram's stains predict the organism cultured,Methods: A retrospective review of prospectively collected data.Results: Gram's stains correlated with the cultured organism in 284 of 543 (52%) SICU cultures and in 226 of 403 (56%) trauma intensive care unit (TICU) cultures, Gram-negative rod (GNR) stains yielded GNR organisms in 182 of 205 (89%) SICU cultures and in 160 of 176 (91%) TICU cultures, Gram-positive coccus (GPC) stains yielded GPC organisms in 75 of 228 (33%) SICU cultures and in 52 of 149 (35%) TICU cultures, Noncorrelates in the GPC group were predominantly GNRs (185 of 250 (74%)).Conclusion: When the clinical decision has been made that empiric antibiotic coverage is necessary, GNR coverage should be instituted regardless of Gram's stain result, The decision to institute GPC coverage needs to be supported by clinical data other than the Gram's stain.