Tracheal aspirate Gram stain has limited sensitivity and specificity for detecting <i>Staphylococcus aureus</i>

Tetenta, Sodienye; Metersky, Mark L.

doi:10.1111/j.1440-1843.2010.01855.x

Cited by 13 publications

(16 citation statements)

References 13 publications

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“…The results of our study are consistent with previous studies that have reported high sensitivity and low false-negative rates for Gram stain used to identify Staphylococcus aureus [23–25]. On the other hand, some studies have reported only a fair correlation between Gram stain and culture [16, 26]. In these studies, some of the patients did not actually have VAP and might have had low-level colonization.…”

Section: Discussionsupporting

confidence: 91%

Impact of Gram stain results on initial treatment selection in patients with ventilator-associated pneumonia: a retrospective analysis of two treatment algorithms

et al. 2017

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Background: Ventilator-associated pneumonia (VAP) is a common and serious problem in intensive care units (ICUs). Several studies have suggested that the Gram stain of endotracheal aspirates is a useful method for accurately diagnosing VAP. However, the usefulness of the Gram stain in predicting which microorganisms cause VAP has not been established. The purpose of this study was to evaluate whether a Gram stain of endotracheal aspirates could be used to determine appropriate initial antimicrobial therapy for VAP.

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Section: Discussionsupporting

confidence: 91%

Impact of Gram stain results on initial treatment selection in patients with ventilator-associated pneumonia: a retrospective analysis of two treatment algorithms

et al. 2017

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“…Namias et al [ 9 ] showed poor overall correlation between Gram positive cocci with the aspirate culture results in a study in which the Gram stain was used to guide empiric antibiotic treatment of pneumonia in surgical ICU patients. Tetenta and Metersky [ 11 ] found that the Gram stain had a sensitivity of 68%, a specificity of 72%, a negative predictive value of 80% and a positive predictive value of 59% for Staphylococcus aureus . However, the authors did not attempt to correlate the Gram stain findings with the presence of VAP.…”

Section: Discussionmentioning

confidence: 99%

“…This rapid test could prevent the initiation of inappropriate therapy when culture results are not available. However, several studies attempting to determine its precision in VAP management have shown conflicting results [ 6 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

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

Seligman

Konkewicz

et al. 2015

BMC Anesthesiol

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BackgroundThe 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.MethodsThis 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.ResultsRespiratory 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).ConclusionsA 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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“…Culture-based microbiological diagnosis remains complicated because the presence of just a few colonizing bacteria in the respiratory tract can result in significant microbial growth on agar cultures and thus can be erroneously interpreted as being indicative of infection. The diagnostic process is further complicated by false-negative results from pathogens that cannot be cultured using standard laboratory procedures, possibly due to prior antibiotic administration or lack of anaerobic transport conditions (10). Combined, these false positives and false negatives significantly reduce the clinical value of deep tracheal aspirate cultures (11)(12)(13).…”

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confidence: 99%

Single-Molecule Long-Read 16S Sequencing To Characterize the Lung Microbiome from Mechanically Ventilated Patients with Suspected Pneumonia

et al. 2014

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iIn critically ill patients, the development of pneumonia results in significant morbidity and mortality and additional health care costs. The accurate and rapid identification of the microbial pathogens in patients with pulmonary infections might lead to targeted antimicrobial therapy with potentially fewer adverse effects and lower costs. Major advances in next-generation sequencing (NGS) allow culture-independent identification of pathogens. The present study used NGS of essentially full-length PCRamplified 16S ribosomal DNA from the bronchial aspirates of intubated patients with suspected pneumonia. The results from 61 patients demonstrated that sufficient DNA was obtained from 72% of samples, 44% of which (27 samples) yielded PCR amplimers suitable for NGS. Out of the 27 sequenced samples, only 20 had bacterial culture growth, while the microbiological and NGS identification of bacteria coincided in 17 (85%) of these samples. Despite the lack of bacterial growth in 7 samples that yielded amplimers and were sequenced, the NGS identified a number of bacterial species in these samples. Overall, a significant diversity of bacterial species was identified from the same genus as the predominant cultured pathogens. The numbers of NGSidentifiable bacterial genera were consistently higher than identified by standard microbiological methods. As technical advances reduce the processing and sequencing times, NGS-based methods will ultimately be able to provide clinicians with rapid, precise, culture-independent identification of bacterial, fungal, and viral pathogens and their antimicrobial sensitivity profiles.

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Tracheal aspirate Gram stain has limited sensitivity and specificity for detecting Staphylococcus aureus

Abstract: In this study, the tracheal aspirate Gram stain read by an experienced clinician who was not a microbiologist, was not accurate enough to reliably predict the growth of S. aureus.

Cited by 13 publications

References 13 publications

Impact of Gram stain results on initial treatment selection in patients with ventilator-associated pneumonia: a retrospective analysis of two treatment algorithms

Impact of Gram stain results on initial treatment selection in patients with ventilator-associated pneumonia: a retrospective analysis of two treatment algorithms

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

Single-Molecule Long-Read 16S Sequencing To Characterize the Lung Microbiome from Mechanically Ventilated Patients with Suspected Pneumonia

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