RT Journal Article
SR Electronic
T1 Diagnostic value of direct examination of the protected specimen brush in ventilator-associated pneumonia
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 105
OP 113
DO 10.1183/09031936.94.07010105
VO 7
IS 1
A1 CH Marquette
A1 F Wallet
A1 R Neviere
A1 MC Copin
A1 F Saulnier
A1 JN Drault
A1 H Mehdaoui
A1 D Mathieu
A1 P Ramon
YR 1994
UL http://erj.ersjournals.com/content/7/1/105.abstract
AB Interpretation of the protected specimen brush (PSB) technique is based on quantitative bacterial cultures (QC), which unfortunately requires at least 24 h. We prospectively compared the diagnostic value of direct examination (DE) and QC of PSB specimens in 75 patients with suspected pneumonia. We also determined the optimal technique for DE. QC was performed using the serial dilution technique. From the original suspension, two cytospin slides were obtained and stained by the May-Grunwald Giemsa (MGG) and the Gram method for DE. If the prescreening on the MGG-stained slide was positive, the morphology and the Gram staining of the organisms were assessed on the Gram-stained slide. Using the 10(3) colony forming units (cfu.ml-1) threshold for defining PSB as positive or negative, DE had a sensitivity of 85% and a specificity of 94%. In a parallel in vitro study, 18 pairs of PSB specimens were collected from respiratory secretions inoculated with S. aureus. From each pair, one brush was processed as described above and the other was smeared on a glass slide prior to performance of QC. Using direct smear instead of cytocentrifuged preparation, slightly but significantly affected QC. Direct examination of cytospin slides is highly predictive of quantitative bacterial culture results, and provides rapid information regarding the Gram-stain morphology of the causative organisms. It may therefore guide initial therapy.