The Diagnostic Value of Gram Stain of Bronchoalveolar Lavage Samples in Patients with Suspected Ventilator-associated Pneumonia

Prekates, A.; Nanas, Serafim; Argyropoulou, Athina; Margariti, Georgia; Kyprianou, Theodoros; Papagalos, Evangelos; Paniara, Olga; Roussos, Charis

doi:10.1080/003655498750002295

Cited by 25 publications

(2 citation statements)

References 9 publications

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“…Studies involving BAL samples found conflicting results on the utility of Gram stains to diagnose pneumonia and de-escalate antibiotic therapy prior to the return of culture and sensitivity results. Studies in the 1990s concluded that BAL Gram stains could be used to aid in VAP diagnosis ( 11 , 12 ). More recent studies have concluded that Gram stains from BALs should not be used to direct initial therapy.…”

Section: Discussionmentioning

confidence: 99%

Bronchoalveolar Lavage Gram Stains for Early Bacterial Identification in Pneumonia: Should They Stay or Should They Go?

Klimko

Sanders

Monogue

et al. 2021

Critical Care Explorations

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OBJECTIVES: The primary endpoint was to determine the sensitivity and specificity of the bronchoalveolar lavage Gram stain in predicting culture results. Secondary endpoints included determining the proportion of Gram stains from bronchoalveolar lavages that accurately identify culture isolates and the duration of antibiotic treatment before bronchoalveolar lavage collection. DESIGN: Retrospective, observational study. SETTING: Four ICUs at a single academic medical center. SUBJECTS: Patients at least 18 years old admitted to an ICU with a diagnosis of pneumonia, collection of a bronchoalveolar lavage sample, and receipt of antibiotics. MEASUREMENTS AND MAIN RESULTS: Two-hundred five isolates were included. Gram stains for Gram-positive and Gram-negative isolates showed high specificity, 97.3% and 100%, respectively, but lower sensitivity at 61.9% and 54.2%, respectively. The positive predictive value and negative predictive value were 77.2% and 95.7% for Gram-positive isolates and 100% and 84.4% for Gram-negative isolates, respectively. Gram stains correctly identified isolates on the bronchoalveolar lavage culture in 61.9% of Gram-positive organisms and in 54.2% of Gram-negative organisms. CONCLUSIONS: Gram stains accurately identified causative organisms in a limited number of patients making the utility of the Gram stain an uncertain modality for predicting causative respiratory pathogens from bronchoalveolar lavage samples.

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Section: Discussionmentioning

confidence: 99%

Bronchoalveolar Lavage Gram Stains for Early Bacterial Identification in Pneumonia: Should They Stay or Should They Go?

Klimko

Sanders

Monogue

et al. 2021

Critical Care Explorations

View full text Add to dashboard Cite

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“…There is still much controversy over the value of the Gram stain for anticipating the microbiological diagnosis of VAP. The medical literature is replete with varying data on the sensitivity (57-95%), specificity (48-87%), positive predictive value (PPV) (47-78%), negative predictive value (NPV) (69-96%) and accuracy (60-88%) of the Gram stain in the management of patients with VAP [ 78 ]-[ 82 ].…”

Section: Main Textmentioning

confidence: 99%

Use of rapid diagnostic techniques in ICU patients with infections

Burillo

Bouza

2014

BMC Infect Dis

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BackgroundInfection is a common complication seen in ICU patients. Given the correlation between infection and mortality in these patients, a rapid etiological diagnosis and the determination of antimicrobial resistance markers are of paramount importance, especially in view of today's globally spread of multi drug resistance microorganisms. This paper reviews some of the rapid diagnostic techniques available for ICU patients with infections.MethodsA narrative review of recent peer-reviewed literature (published between 1995 and 2014) was performed using as the search terms: Intensive care medicine, Microbiological techniques, Clinical laboratory techniques, Diagnosis, and Rapid diagnosis, with no language restrictions.ResultsThe most developed microbiology fields for a rapid diagnosis of infection in critically ill patients are those related to the diagnosis of bloodstream infection, pneumonia -both ventilator associated and non-ventilator associated-, urinary tract infection, skin and soft tissue infections, viral infections and tuberculosis.ConclusionsNew developments in the field of microbiology have served to shorten turnaround times and optimize the treatment of many types of infection. Although there are still some unresolved limitations of the use of molecular techniques for a rapid diagnosis of infection in the ICU patient, this approach holds much promise for the future.

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Ventilator-Associated Pneumonia

Morehead¹,

Pinto²

2000

Arch Intern Med

110

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Ventilator-associated pneumonia is a common complication in intensive care units, occurring in 9% to 24% of patients intubated for longer than 48 hours. Because of this large disease burden and the resultant attributable morbidity and mortality, there is great interest in accurately diagnosing, treating, and preventing this complication. More severely ill patients tend to develop ventilator-associated pneumonia, and identified risk factors include prolonged mechanical ventilation, reintubation after failed extubation, and a few other clinical variables. The efficacy of diagnostic and preventive strategies is somewhat controversial. Diagnosis by invasive methods requires a considerable commitment of resources but can potentially reduce cost of care; however, mortality benefit from this approach has not been demonstrated. As such, in most institutions, ventilator-associated pneumonia is best diagnosed using traditional clinical criteria. Prompt administration of appropriate antibiotics seems to be the only intervention that alters outcome once the diagnosis is established. Several strategies seem to reduce pneumonia incidence; however, mortality and cost benefits have yet to be convincingly shown.

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The Diagnostic Value of Gram Stain of Bronchoalveolar Lavage Samples in Patients with Suspected Ventilator-associated Pneumonia

Cited by 25 publications

References 9 publications

Bronchoalveolar Lavage Gram Stains for Early Bacterial Identification in Pneumonia: Should They Stay or Should They Go?

Bronchoalveolar Lavage Gram Stains for Early Bacterial Identification in Pneumonia: Should They Stay or Should They Go?

Use of rapid diagnostic techniques in ICU patients with infections

Ventilator-Associated Pneumonia

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