Department of Emergency and the Intensive Care Unit, Chongqing Hospital of Traditional Chinese Medicine.
Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine.
J Vis Exp. 2024 Mar 1(205). doi: 10.3791/66059.
The prompt initiation of empirical anti-infective therapy is crucial in patients presenting with unexplained pulmonary infection. Although imaging acquisition is relatively straightforward in clinical practice, its lack of specificity often necessitates additional time-consuming tests such as sputum culture, bronchoalveolar-lavage fluid culture, or genetic sequencing to identify the underlying etiology of the disease accurately. Moreover, the limited efficacy of empirical anti-infective treatment may contribute to antibiotic misuse. Recent advancements in interpreting microbial background on rapid on-site evaluation (ROSE) slides have enabled clinicians to promptly obtain samples through bronchoscopy (e.g., alveolar lavage, mucosal brushing, tissue clamp), facilitating bedside staining and interpretation that provides essential microbial background information. Consequently, this establishes a foundation for developing targeted anti-infection treatment and individualized drug therapy plans. With a better understanding of which pathogens are causing infections in real-time, physicians can avoid unnecessary broad-spectrum antibiotics contributing to antibiotic resistance. Establishing a rapid and standardized M-ROSE workflow within respiratory medicine departments or intensive care units will greatly assist physicians in formulating accurate treatment strategies for patients, which holds significant clinical implications.
经验性抗感染治疗的及时启动对不明原因肺部感染患者至关重要。虽然在临床实践中，影像学采集相对简单直接，但由于其特异性不足，通常需要进行额外的耗时测试，如痰培养、支气管肺泡灌洗液培养或基因测序，以准确识别疾病的潜在病因。此外，经验性抗感染治疗的疗效有限可能导致抗生素的滥用。快速现场评估 (ROSE) 载玻片上微生物背景解读的最新进展使临床医生能够通过支气管镜（如肺泡灌洗、黏膜刷检、组织夹取）及时获取样本，便于在床边进行染色和解读，从而提供重要的微生物背景信息。因此，这为制定针对性抗感染治疗和个体化药物治疗方案奠定了基础。通过实时了解哪些病原体导致感染，医生可以避免因使用不必要的广谱抗生素而导致的抗生素耐药性。在呼吸科或重症监护病房内建立快速而标准化的 M-ROSE 工作流程，将极大地帮助医生为患者制定准确的治疗策略，这具有重要的临床意义。
