Geckler R W, McAllister C K, Gremillion D H, Ellenbogen C
Chest. 1985 May;87(5):631-5. doi: 10.1378/chest.87.5.631.
One hundred young adults with acute pneumonia were prospectively studied to determine the impact of the transtracheal aspiration (TTA) Gram stain on immediate management. Sputum and TTA interpretations by staff and housestaff were compared. After a management plan was elected based on sputum Gram stain interpretation, the TTA was evaluated and the final plan chosen. A change in treatment after the TTA was available occurred in eight cases, and this was an appropriate change in only five. The putative pathogen as identified by TTA culture was correctly predicted after sputum Gram stain interpretation in 36 to 62 percent of cases and after TTA interpretation in 37 to 62 percent. This indicates significant observer variation but not superiority of one type of specimen over the other. In most cases, paired sputum and TTA Gram stain were both read correctly or incorrectly. When differences occurred, sputum interpretations were as likely to be correct as were TTA interpretations. The TTA Gram stain offered no advantage over sputum Gram stain in the initial management of acute pneumonia in this young adult military population.
对100名患有急性肺炎的年轻成年人进行了前瞻性研究，以确定经气管吸引（TTA）革兰氏染色对即时治疗的影响。比较了工作人员和实习医生对痰液和TTA的解读。在根据痰液革兰氏染色解读选定治疗方案后，对TTA进行评估并选择最终方案。在获得TTA结果后，有8例患者的治疗方案发生了改变，其中只有5例改变是恰当的。经痰液革兰氏染色解读后，TTA培养鉴定出的假定病原体在36%至62%的病例中得到正确预测，经TTA解读后在37%至62%的病例中得到正确预测。这表明观察者之间存在显著差异，但两种标本类型并无优劣之分。在大多数情况下，成对的痰液和TTA革兰氏染色结果要么都被正确解读，要么都被错误解读。当出现差异时，痰液解读正确的可能性与TTA解读正确的可能性相同。在这群年轻成年军人急性肺炎的初始治疗中，TTA革兰氏染色相对于痰液革兰氏染色并无优势。
