Renshaw A A
Brigham and Women's Hospital, Department of Pathology, Boston, MA 02115.
Am J Clin Pathol. 1994 Dec;102(6):736-40. doi: 10.1093/ajcp/102.6.736.
The author compared the efficacy of Gram's, methenamine silver, and acid-fast stains on tissue sections to conventional culture methods in vitro for detecting infection in 110 open lung biopsies (99 inflammatory, 11 neoplastic). Twenty-one cases of clinically significant infection were found (19%). Gram's stain and culture had sensitivities of 100% and 80%, respectively. However, 21 of the cultures grew clinically irrelevant organisms and 2 Gram's stains originally were misinterpreted. In contrast, methenamine silver and acid--fast stains were significantly more sensitive (80% and 100%) than their corresponding cultures (20% and 50%) and no methenamine silver or acid-fast stains were misinterpreted. In addition, methenamine silver stain had a higher positive predictive value than culture (100% vs. 60%). In conclusion, both methenamine silver and acid-fast stains are more sensitive than culture for detecting significant pathogens from open lung biopsies. Gram's stain is as sensitive as bacterial culture but is often misinterpreted. Moreover, interpretation of bacterial cultures is complicated by the frequent growth of clinically insignificant organisms.
作者将组织切片上革兰氏染色、亚甲胺银染色和抗酸染色检测感染的效果与传统培养方法在体外对110例开放性肺活检标本（99例炎症性、11例肿瘤性）进行检测的效果进行了比较。发现21例具有临床意义的感染病例（19%）。革兰氏染色和培养的敏感性分别为100%和80%。然而，有21份培养物生长出临床上无意义的微生物，且最初有2份革兰氏染色被误判。相比之下，亚甲胺银染色和抗酸染色比相应的培养方法（分别为20%和50%）显著更敏感（80%和100%），且没有亚甲胺银或抗酸染色被误判。此外，亚甲胺银染色的阳性预测值高于培养（100%对60%）。总之，亚甲胺银染色和抗酸染色在从开放性肺活检标本中检测重要病原体方面比培养更敏感。革兰氏染色与细菌培养一样敏感，但常被误判。此外，细菌培养的解读因临床上无意义微生物的频繁生长而变得复杂。
