Namias N, Harvill S, Ball S, McKenney M G, Sleeman D, Ladha A, Civetta J
Emory University School of Medicine, Atlanta, Georgia 30303, USA.
J Trauma. 1998 Jan;44(1):102-6. doi: 10.1097/00005373-199801000-00012.
Tracheal aspirate Gram's stains are used to guide antibiotic selection in empiric pneumonia treatment in the surgical intensive care unit (SICU). We questioned whether Gram's stains predict the organism cultured.
A retrospective review of prospectively collected data.
Gram's stains correlated with the cultured organism in 284 of 543 (52%) SICU cultures and in 226 of 403 (56%) trauma intensive care unit (TICU) cultures. Gram-negative rod (GNR) stains yielded GNR organisms in 182 of 205 (89%) SICU cultures and in 160 of 176 (91%) TICU cultures. Gram-positive coccus (GPC) stains yielded GPC organisms in 75 of 228 (33%) SICU cultures and in 52 of 149 (35%) TICU cultures. Noncorrelates in the GPC group were predominantly GNRs (185 of 250 (74%)).
When the clinical decision has been made that empiric antibiotic coverage is necessary, GNR coverage should be instituted regardless of Gram's stain result. The decision to institute GPC coverage needs to be supported by clinical data other than the Gram's stain.
在外科重症监护病房（SICU）治疗经验性肺炎时，气管吸出物革兰氏染色用于指导抗生素的选择。我们质疑革兰氏染色是否能预测培养出的病原体。
对前瞻性收集的数据进行回顾性分析。
在543份SICU培养物中的284份（52%）以及403份创伤重症监护病房（TICU）培养物中的226份（56%）中，革兰氏染色与培养出的病原体相关。革兰氏阴性杆菌（GNR）染色在205份SICU培养物中的182份（89%）以及176份TICU培养物中的160份（91%）中培养出GNR病原体。革兰氏阳性球菌（GPC）染色在228份SICU培养物中的75份（33%）以及149份TICU培养物中的52份（35%）中培养出GPC病原体。GPC组中不相关的主要是GNR（250份中的185份（74%））。
当临床决定需要进行经验性抗生素覆盖时，无论革兰氏染色结果如何，都应开始覆盖GNR。决定开始覆盖GPC需要革兰氏染色以外的临床数据支持。
