《气道分泌物培养的临床意义》ppt课件.pptVIP

VAP治疗 – 革兰染色结果 Questions Answers In the case of a negative Gram’s stain of a respiratory sample of a patient with a suspicion of VAP, would you wait for cultures to start antibiotics? No Depending on the patient* (10/12) (2/12) Rello J, Paiva JA, Baraibar J, et al. International conference for the development of consensus on the diagnosis and treatment of ventilator-associated pneumonia. Chest 2001; 120: 955-970 *Yes if the clinical situation clearly suggestive of pneumonia and if patient at high risk or clinically deteriorating VAP治疗 – 革兰染色结果 完全符合 部分符合 不符合 Allaouchiche (n = 51) 26 20 5 Duflo (n = 67) 26 19 22 Davis (n = 155) 71 54 30 Raghavendran (n = 186) 90 37 50 Albert (n = 705) 389 108 208 总计(n = 1164) 602 (51.7) 238 (20.4) 324 (27.8) 仅有1/2的VAP病例ETA革兰染色结果与培养结果相符 Allaouchiche B, Jaumain H, Chassard D, et al. Gram stain of bronchoalveolar lavage fluid in the early diagnosis of ventilator-associated pneumonia. Br J Anaesth 1999; 83: 845-849 Duflo F, Allaouchiche B, Debon R, et al. An evaluation of the Gram stain in protected bronchoalveolar lavage fluid for the early diagnosis of ventilator-associated pneumonia. Anesth Analg 2001; 92: 442-447 Davis KA, Eckert MJ, Reed RL II, et al. Ventilator-associated pneumonia in injured patients: do you trust your Gram stain? J Trauma 2005; 58: 462-466 Raghavendran K, Wang J, Belber C, et al. Predictive value of sputum Gram stain for the determination of appropriate antibiotic therapy in ventilator-associated pneumonia. J Trauma 2007; 62: 1377-1383 Albert M, Friedrich JO, Adhikari NKJ, et al. Utility of Gram stain in the clinical management of suspected ventilator-associated pneumonia: secondary analysis of a multicenter randomized trial. J Crit Care 2008; 23: 74-81 VAP治疗 – 革兰染色结果 Veinstein A, Brun-Buisson C, Derrode N, et al. Validation of an algorithm based on direct examination of specimens in suspected ventilator-associated pneumonia. Intensive Care Med 2006; 32: 676-683 Suspected VAP PTC Gram stain -ve ETA Gram stain +