生殖器革兰氏染色在 ED 患者中的诊断价值。

Diagnostic utility of the genital Gram stain in ED patients.

机构信息

University of Illinois College of Medicine at Peoria, Peoria, IL 61637, USA.

出版信息

Am J Emerg Med. 2010 Jan;28(1):13-8. doi: 10.1016/j.ajem.2008.09.016.

DOI:10.1016/j.ajem.2008.09.016

PMID:20006195

Abstract

OBJECTIVE

The study aimed to determine the diagnostic usefulness of the genital Gram stain in an emergency department (ED) population.

METHODS

A linked-query of an urban, tertiary-care, university- affiliated hospital laboratory database was conducted for all completed Chlamydia trachomatis and Neisseria gonorrhoeae DNA probes, Trichomonas vaginalis wet preps, and genital Gram stains performed on ED patient visits between January and December 2004. Positive criteria for a Gram stain included greater than 10 white blood cells per high-power field, gram-negative intracellular/extracellular diplococci (suggesting N gonorrhoeae), clue cells (suggesting T vaginalis), or direct visualization of T vaginalis organisms. DNA probes were used as the gold standard definition for N gonorrhoeae and C trachomatis infection.

RESULTS

Of 1511 initially eligible ED visits, 941 were analyzed (genital Gram stain and DNA probe results both present), with a prevalence of either C trachomatis or N gonorrhoeae of 11.4%. A positive genital Gram stain was 75.7% sensitive and 43.3% specific in diagnosing either C trachomatis and/or N gonorrhoeae infection, and 80.4% sensitive and 32.2% specific when the positive cutoff was lowered to more than 5 white blood cells/high-power field. No Gram stains were positive for T vaginalis (with 47 positive wet mounts), and clue cells were noted on 117 Gram stains (11.6%).

CONCLUSION

Gram stains in isolation lack sufficient diagnostic ability to detect either C trachomatis or N gonorrhoeae infection in the ED.

摘要

目的

本研究旨在确定生殖器革兰氏染色在急诊科（ED）人群中的诊断价值。

方法

对 2004 年 1 月至 12 月期间在 ED 就诊的所有完成的沙眼衣原体和淋病奈瑟菌 DNA 探针、阴道毛滴虫湿片和生殖器革兰氏染色的城市、三级保健、大学附属医院实验室数据库进行了链接查询。革兰氏染色的阳性标准包括每高倍视野白细胞大于 10 个、革兰氏阴性细胞内/细胞外双球菌（提示淋病奈瑟菌）、线索细胞（提示阴道毛滴虫）或直接观察到阴道毛滴虫。DNA 探针被用作淋病奈瑟菌和沙眼衣原体感染的金标准定义。

结果

在最初符合条件的 1511 次 ED 就诊中，有 941 次进行了分析（生殖器革兰氏染色和 DNA 探针结果均存在），沙眼衣原体或淋病奈瑟菌的患病率为 11.4%。阳性生殖器革兰氏染色在诊断沙眼衣原体和/或淋病奈瑟菌感染时的敏感性为 75.7%，特异性为 43.3%，当阳性截定点降低至每高倍视野白细胞超过 5 个时，敏感性为 80.4%，特异性为 32.2%。没有革兰氏染色显示阴道毛滴虫阳性（47 例湿片阳性），117 例革兰氏染色显示线索细胞（11.6%）。