Reimer L G, Carroll K C
Department of Medicine (Division of Infectious Diseases), University of Utah Health Sciences Center, Salt Lake City, USA.
Clin Infect Dis. 1998 Mar;26(3):742-8. doi: 10.1086/514583.
The appropriate use of the clinical microbiology laboratory for diagnosing lower respiratory tract infections is controversial. As in clinical care, it is crucial to categorize the presenting illness properly as acute bronchitis, an acute exacerbation of chronic bronchitis, community-acquired pneumonia, or nosocomial pneumonia if diagnostic efforts to establish a microbial etiology are to be productive for the individual patient and affordable to society. The greatest potential benefit of microbiological investigations lies in the etiologic diagnosis of pneumonia. For community-acquired pneumonia, evaluation of a gram-stained smear of sputum in terms of both quality and microorganisms present can help guide initial therapy as well as aid interpretation of subsequent culture results. As discussed in this review, the role of the clinical microbiology laboratory in the etiologic diagnosis of nosocomial and complicated pneumonias is more extensive and, in addition to evaluation of respiratory secretions, may include cultures of blood, pleural fluid, and specimens obtained by bronchoscopy. However, a prerequisite for the use of all currently available tests is their deployment for patients with clinical and radiographic evidence of pneumonia.
临床微生物实验室在诊断下呼吸道感染方面的合理应用存在争议。与临床护理一样，如果要使针对个体患者确定微生物病因的诊断工作取得成效且对社会而言成本可承受，那么将当前疾病正确分类为急性支气管炎、慢性支气管炎急性加重、社区获得性肺炎或医院获得性肺炎至关重要。微生物学检查的最大潜在益处在于肺炎的病因诊断。对于社区获得性肺炎，从质量和存在的微生物方面评估痰涂片革兰氏染色有助于指导初始治疗以及辅助解释后续培养结果。如本综述所讨论的，临床微生物实验室在医院获得性肺炎和复杂性肺炎的病因诊断中的作用更为广泛，除了评估呼吸道分泌物外，可能还包括血培养、胸腔积液培养以及通过支气管镜获取的标本培养。然而，使用所有现有检测方法的一个前提条件是将其用于有肺炎临床和影像学证据的患者。
