Journal
AMERICAN JOURNAL OF SURGERY
Volume 192, Issue 6, Pages 812-815Publisher
EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
DOI: 10.1016/j.amjsurg.2006.08.049
Keywords
Gram's stain; ventilator-associated pneumonia; bronchoalveolar lavage
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Background: Although Gram's stain (GS) of bronchoalveolar lavage fluid is routinely obtained, its usefulness remains unclear. Our purpose was to assess the value of the GS in diagnosing ventilator-associated pneumonia (VAP) and to determine whether early antibiotic narrowing was feasible. Methods: Retrospective study of critically ill surgical patients with clinical and quantitative evidence of VAR GS and culture data were collated and analyzed. Results: GS results correlated with cultured organisms in 60% of cases. Overall accuracy of GS in diagnosing VAP for any organism was 58%. Gram-negative rod staining yielded like pneumonia at a statistically higher rate than Gram-positive cocci. A lack of bacteria on GS demonstrated no growth on culture 26.5% of the time, revealing the poorest correlation of all. Conclusions: GS cannot be a reliable surrogate for quantitative culture. Altering antibiotic therapy based on GS could lead to inappropriate therapy and, presumably, greater morbidity and mortality. (c) 2006 Excerpta Medica Inc. All rights reserved.
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