Chastre J, Fagon J Y, Domart Y, Gibert C
Service de Réanimation Médicale, Hôpital Bichat, Paris, France.
Eur J Clin Microbiol Infect Dis. 1989 Jan;8(1):35-9. doi: 10.1007/BF01964118.
The optimal technique for diagnosing nosocomial bacterial pneumonia in critically ill patients cared for in the intensive care unit remains unclear, especially in the subgroup of patients requiring mechanical ventilation. An important advance has been the development of the protected specimen brush technique. We and others have demonstrated that secretions obtained using this technique and evaluated by quantitative cultures are useful in distinguishing patients with and without pneumonia. However, this procedure has important limitations in that results are not available immediately and in that a few false negative or false positive results may be observed. Recently, the use of bronchoalveolar lavage has been suggested to be of value in establishing the diagnosis of pneumonia, since the cells and liquid recovered can be examined microscopically immediately after the procedure and are also suitable for quantitative culture. We believe that microscopic identification of bacteria within cells recovered by lavage may provide a sensitive and specific means for early and rapid diagnosis of pneumonia in this setting and that the lavage technique can be conveniently incorporated into a protocol along with the quantitative culture of samples obtained using the protected specimen brush. This combination will probably improve the overall accuracy of diagnosis while allowing the administration of prompt empiric antimicrobial therapy in the majority of patients with pneumonia.
在重症监护病房接受治疗的重症患者中，诊断医院获得性细菌性肺炎的最佳技术仍不明确，尤其是在需要机械通气的患者亚组中。一项重要进展是保护性标本刷技术的发展。我们和其他人已经证明，使用该技术获得并通过定量培养评估的分泌物有助于区分患有和未患肺炎的患者。然而，该程序有重要局限性，即结果不能立即获得，并且可能会观察到一些假阴性或假阳性结果。最近，有人提出使用支气管肺泡灌洗在肺炎诊断中具有价值，因为回收的细胞和液体在操作后可立即进行显微镜检查，并且也适合进行定量培养。我们认为，通过灌洗回收的细胞内细菌的显微镜鉴定可能为在这种情况下早期快速诊断肺炎提供一种敏感且特异的方法，并且灌洗技术可以方便地与使用保护性标本刷获得的样本的定量培养一起纳入方案中。这种联合可能会提高总体诊断准确性，同时允许在大多数肺炎患者中及时给予经验性抗菌治疗。
