Accuracy of tracheal aspirate gram stain in predicting Staphylococcus aureus infection in ventilator-associated pneumonia

被引:18
|
作者
Seligman, Renato [1 ,2 ]
Santos Seligman, Beatriz Graeff [1 ,2 ]
Konkewicz, Loriane [1 ]
dos Santos, Rodrigo Pires [1 ]
机构
[1] Hosp Clin Porto Alegre, BR-90035003 Porto Alegre, RS, Brazil
[2] Univ Fed Rio Grande do Sul, BR-90035003 Porto Alegre, RS, Brazil
来源
BMC ANESTHESIOLOGY | 2015年 / 15卷
关键词
Staphylococcus aureus; Gram stain; Tracheal aspirate; Ventilator-associated pneumonia; ANTIBIOTIC-TREATMENT; DIAGNOSIS; MANAGEMENT; THERAPY; IMPACT;
D O I
10.1186/1471-2253-15-19
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: 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. Methods: 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. Results: 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). Conclusions: 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.
引用
收藏
页数:5
相关论文
共 50 条
  • [1] Accuracy of tracheal aspirate gram stain in predicting Staphylococcus aureus infection in ventilator-associated pneumonia
    Renato Seligman
    Beatriz Graeff Santos Seligman
    Loriane Konkewicz
    Rodrigo Pires dos Santos
    BMC Anesthesiology, 15
  • [2] The accuracy of Gram stain of respiratory specimens in excluding Staphylococcus aureus in ventilator-associated pneumonia
    Gottesman, Tamar
    Yossepowitch, Orit
    Lerner, Evgenia
    Schwartz-Harari, Orna
    Soroksky, Arie
    Yekutieli, Daniel
    Dan, Michael
    JOURNAL OF CRITICAL CARE, 2014, 29 (05) : 739 - 742
  • [3] Can The Presence Of Gram-Positive Cocci In Tracheal Aspirate Reliably Predict The Presence Of Staphylococcus Aureus As A Causative Agent In Ventilator-Associated Pneumonia?
    Seligman, B. G. S.
    Mello, C. D. B.
    Kochi, A. N.
    Monteggia, R. G.
    Braun, A. C.
    Bourscheit, F.
    Seligman, R.
    AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2013, 187
  • [4] Quantitative surveillance tracheal aspirate dynamics as a predictor of ventilator-associated pneumonia
    Wear, Robert E.
    Morrow, Lee E.
    CRITICAL CARE MEDICINE, 2007, 35 (12) : A219 - A219
  • [5] Tracheal aspirate Gram stain has limited sensitivity and specificity for detecting Staphylococcus aureus
    Tetenta, Sodienye
    Metersky, Mark L.
    RESPIROLOGY, 2011, 16 (01) : 86 - 89
  • [6] Rapid diagnosis of ventilator-associated pneumonia caused Staphylococcus aureus
    Allaouchiche, B
    David, JS
    Chassard, D
    ANESTHESIOLOGY, 1998, 89 (3A) : U351 - U351
  • [7] The burden of methicillin resistant staphylococcus aureus in ventilator-associated pneumonia
    Shorr, AF
    Tabak, Y
    Gupta, V
    Johannes, R
    Liu, LZ
    Kollef, MH
    CHEST, 2004, 126 (04) : 716S - 717S
  • [8] Gram stain of bronchoalveolar lavage fluid in the early diagnosis of ventilator-associated pneumonia
    Allaouchiche, B
    Jaumain, H
    Chassard, D
    Boulétreau, P
    BRITISH JOURNAL OF ANAESTHESIA, 1999, 83 (06) : 845 - 849
  • [9] Predicting ventilator-associated pneumonia
    McEnery, Tom
    Martin-Loeches, Ignacio
    ANNALS OF TRANSLATIONAL MEDICINE, 2020, 8 (11)
  • [10] Impact of methicillin resistance on outcome of Staphylococcus aureus ventilator-associated pneumonia
    Combes, A
    Luyt, CE
    Fagon, JY
    Wollf, M
    Trouillet, JL
    Gibert, C
    Chastre, J
    AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2004, 170 (07) : 786 - 792