Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-23T02:13:58.339Z Has data issue: false hasContentIssue false
  • English
  • Français

Concordance of antibiotic prophylaxis, direct Gram staining and protected brush specimen culture results for postoperative patients with suspected pneumonia

Published online by Cambridge University Press:  27 January 2006

J.-M. Maillet ,
F. Fitoussi ,
D. Penaud ,
G. Dennewald  and
D. Brodaty
J.-M. Maillet
Affiliation:
Cardiovascular and Thoracic Surgery Intensive Care Unit, Centre Cardiologique du Nord, Saint Denis, France
F. Fitoussi
Affiliation:
Department of Microbiology, Centre Cardiologique du Nord, Saint Denis, France
D. Penaud
Affiliation:
Pneumology, Centre Cardiologique du Nord, Saint Denis, France
G. Dennewald
Affiliation:
Pneumology, Centre Cardiologique du Nord, Saint Denis, France
D. Brodaty
Affiliation:
Cardiovascular and Thoracic Surgery Intensive Care Unit, Centre Cardiologique du Nord, Saint Denis, France
Get access

Extract

Summary

Background and objectives: Antibiotic therapy alters the diagnostic value of protected brush specimens. With protected brush specimens alone, diagnosing pneumonia requires 24 or 48 h. Addition of direct Gram staining shortens this delay. Antibiotic prophylaxis, recommended after major surgery, may influence the contribution of Gram staining to diagnosing postoperative pneumonia. Methods: During a 1-yr period, we retrospectively studied all patients on mechanical ventilation suspected of having postoperative pneumonia who had undergone fibreoptic bronchoscopy with protected brush specimens. Postoperative pneumonia was diagnosed when quantitative protected brush specimens culture results yielded 103 colony-forming units mL−1. Results: Fifty patients were clinically suspected of having postoperative pneumonia after cardiac (n = 42), vascular (n = 5) or thoracic (n = 3) surgery. Eleven (22%) samples were obtained during antibiotic prophylaxis. Twenty-two (44%) episodes were microbiologically proven. Gram-stain sensitivity was 95.5%, with 82.1% specificity, 80.7% positive-predictive value and 95.8% negative-predictive value. Concordance between direct Gram-stain-identified pathogens and Gram stain of cultured pathogens was significantly less frequent during antibiotic prophylaxis (63.6%) than afterwards (94.9%) (P < 0.05). Conclusion: Antibiotic prophylaxis diminished the diagnostic value of Gram staining of protected brush specimens. When protected brush specimens was performed during antibiotic prophylaxis, Gram staining accurately enabled early exclusion of postoperative pneumonia because of its excellent negative-predictive value. After antibiotic prophylaxis, Gram staining permitted early diagnosis of postoperative pneumonia identification of the responsible pathogen.

Keywords

ANTIBIOTIC PROPHYLAXISGRAM'S STAINPOSTOPERATIVE COMPLICATIONSPNEUMONIABRONCHOSCOPY, protected brush specimen
Type
EACTA Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 7 , July 2006 , pp. 563 - 567
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Stephan F, Boucheseiche S, Hollande J et al. Pulmonary complications following lung resection. Chest 2000; 118: 1263–1270.Google Scholar
Leal-Noval SR, Marquez-Vacaro JA, Garcia-Curiel A et al. Nosocomial pneumonia in patients undergoing heart surgery. Crit Care Med 2000; 28: 935–940.Google Scholar
Hall JC, Taral R, Harris J et al. Incentive spirometry versus routine chest physiotherapy for prevention of pulmonary complications after abdominal surgery. Lancet 1991; 337: 953–956.Google Scholar
Garibaldi RA, Britt MR, Coleman ML et al. Risk factors for postoperative pneumonia. Am J Med 1981; 70: 677–680.Google Scholar
Andrews CP, Coalson JJ, Smith JD et al. Diagnosis of nosocomial bacterial pneumonia in acute, diffuse lung injury. Chest 1981; 80: 254–258.Google Scholar
Fagon JY, Chastre J, Hance AJ et al. Detection of nosocomial lung infection in ventilated patients. Use of a protected specimen brush and quantitative culture techniques in 147 patients. Am Rev Respir Dis 1988; 138: 106–111.Google Scholar
Chastre J, Viau F, Brun P et al. Prospective evaluation of protected specimen brush for the diagnosis of pulmonary infections in ventilated patients. Am Rev Respir Dis 1984; 130: 924–929.Google Scholar
Meduri GU, Mauldin GL, Wunderink RG et al. Causes of fever and pulmonary densities in patients with clinical manifestations of ventilator-associated pneumonia. Chest 1994; 106: 221–235.Google Scholar
Circiumaru B, Baldock G, Cohen J. A prospective study of fever in the intensive care unit. Intens Care Med 1999; 25: 668–673.Google Scholar
Fagon JY, Chastre J, Hance AJet al. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 1993; 94: 281–288.Google Scholar
de Jaeger A, Litalien C, Lacroix J et al. Protected specimen brush or bronchoalveolar lavage to diagnose bacterial nosocomial pneumonia in ventilated adults: a meta-analysis. Crit Care Med 1999; 27: 2548–2560.Google Scholar
Marquette CH, Wallet F, Neviere R et al. Diagnostic value of direct examination of the protected specimen brush in ventilator-associated pneumonia. Eur Respir J 1994; 7: 105–113.Google Scholar
Mimoz O, Karim A, Mazoit JX et al. Gram staining of protected pulmonary specimens in the early diagnosis of ventilator-associated pneumonia. Br J Anaesth 2000; 85: 735–739.Google Scholar
Blot F, Raynard B, Chachaty E, Tancrede C, Antoun S, Nitenberg G. Value of Gram staining examination of lower respiratory tract secretions for early diagnosis of nosocomial pneumonia. Am J Resp Crit Care Med 2000; 162: 1731–1737.Google Scholar
Veber B, Souweine B, Gachot B et al. Comparison of direct examination of three types of bronchoscopy specimens used to diagnose nosocomial pneumonia. Crit Care Med 2000; 28: 962–968.Google Scholar
Société Française d'Anesthésie et de Réanimation (SFAR). Antibioprophylaxie en milieu chirurgical chez l'adulte. Ann Fr Anesth Reanim 1993; 12: 337–354.
Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/ North American multi-center study. JAMA 1993; 270: 2957–2963.Google Scholar
Rello J, Mariscal D, Gallego M et al. Effect of enriched thioglycolate on direct examination of respiratory specimens and guiding initial empirical therapy in intubated patients with pneumonia: a prospective, randomized study. Crit Care Med 2002; 30: 311–314.Google Scholar
Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002; 165: 867–903.Google Scholar
Baughman RP. Protected-specimen brush technique in the diagnosis of ventilator-associated pneumonia. Chest 2000; 117 (Suppl 2): 203S–206S.Google Scholar
Pennington JH, Grady FO. Reversal of the action of penicillin. Nat New Biol 1967; 213: 34–35.Google Scholar
Souweine B, Veber B, Bedos JP et al. Diagnosis accuracy of protected specimen brush and bronchoalveolar lavage in nosocomial pneumonia: impact of previous antimicrobial treatments. Crit Care Med 1998; 26: 236–244.Google Scholar
Barza M, Melethil S, Berger S, Ernst C. Comparative pharmacokinetics of cefamandole, cephapirin and cephalotin in healthy subjects and effect of repeat dosing. Antimicrob Agents Chemother 1976; 10: 421–425.Google Scholar
Valles J, Rello J, Fernandez R et al. Role of bronchoalveolar lavage in mechanically ventilated patients with suspected pneumonia. Eur J Clin Microbiol Infect Dis 1994; 13: 549–558.Google Scholar