Ventilator-associated pneumonia in injured patients

Do you trust your Gram's stain?

Kimberly A. Davis, Matthew J. Eckert, R. Lawrence Reed, Thomas J. Esposito, John M. Santaniello, Stathis Poulakidas, Fred A. Luchette, Karen Brasel, Philip S. Barie, Ajai Malhotra

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: The results of sputum or bronchoalveolar lavage (BAL) fluid Gram's stain have been used to guide presumptive antibiotic therapy for ventilator-associated pneumonia (VAP) in injured patients, despite reported variability in sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Our aim was to evaluate the utility of Gram's stain of BAL fluid in the diagnosis of VAP. Methods: We conducted a retrospective chart review of all mechanically ventilated trauma patients who developed pneumonia over a 5-year period in whom Gram's stain and final culture data were available. Results: One hundred fifty-five records with complete data sets were reviewed. VAP was diagnosed by Centers for Disease Control and Prevention criteria and confirmed by BAL and quantitative culture in all patients. Overall accuracy of Gram's stain in diagnosing VAP for any organism was 88 % (137 true-positives). When assessed for the ability to predict pneumonia caused by a specific organism, the accuracy decesased significantly, with only 63% of Gram-negative VAPs and 72% of Gram-positive VAPs accurately identified by Gram's stain. However, the absence of Gram-positive organism of Gram's stain excludes Gram-positive VAP in 80% of patients. Conclusion: All trauma patients should be covered presumptively for gram-negative organisms, as they encompass 70% of infections, but are not reliably identified by Gram's stain. As 88% of VAP can be identified by the presence of any organism on Gram's stain, it may be useful in the early diagnosis of VAP but cannot reliably be used to guide presumptive therapy.

Original languageEnglish (US)
Pages (from-to)462-467
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume58
Issue number3
DOIs
StatePublished - Mar 2005
Externally publishedYes

Fingerprint

Ventilator-Associated Pneumonia
Bronchoalveolar Lavage Fluid
Pneumonia
Aptitude
Gram's stain
Wounds and Injuries
Bronchoalveolar Lavage
Centers for Disease Control and Prevention (U.S.)
Sputum
Early Diagnosis
Anti-Bacterial Agents
Sensitivity and Specificity
Therapeutics

Keywords

  • Gram's stain
  • Microbiology
  • Pneumonia
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Davis, K. A., Eckert, M. J., Reed, R. L., Esposito, T. J., Santaniello, J. M., Poulakidas, S., ... Malhotra, A. (2005). Ventilator-associated pneumonia in injured patients: Do you trust your Gram's stain? Journal of Trauma - Injury, Infection and Critical Care, 58(3), 462-467. https://doi.org/10.1097/01.TA.0000153941.39697.AA

Ventilator-associated pneumonia in injured patients : Do you trust your Gram's stain? / Davis, Kimberly A.; Eckert, Matthew J.; Reed, R. Lawrence; Esposito, Thomas J.; Santaniello, John M.; Poulakidas, Stathis; Luchette, Fred A.; Brasel, Karen; Barie, Philip S.; Malhotra, Ajai.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 58, No. 3, 03.2005, p. 462-467.

Research output: Contribution to journalArticle

Davis, KA, Eckert, MJ, Reed, RL, Esposito, TJ, Santaniello, JM, Poulakidas, S, Luchette, FA, Brasel, K, Barie, PS & Malhotra, A 2005, 'Ventilator-associated pneumonia in injured patients: Do you trust your Gram's stain?', Journal of Trauma - Injury, Infection and Critical Care, vol. 58, no. 3, pp. 462-467. https://doi.org/10.1097/01.TA.0000153941.39697.AA
Davis, Kimberly A. ; Eckert, Matthew J. ; Reed, R. Lawrence ; Esposito, Thomas J. ; Santaniello, John M. ; Poulakidas, Stathis ; Luchette, Fred A. ; Brasel, Karen ; Barie, Philip S. ; Malhotra, Ajai. / Ventilator-associated pneumonia in injured patients : Do you trust your Gram's stain?. In: Journal of Trauma - Injury, Infection and Critical Care. 2005 ; Vol. 58, No. 3. pp. 462-467.
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title = "Ventilator-associated pneumonia in injured patients: Do you trust your Gram's stain?",
abstract = "Background: The results of sputum or bronchoalveolar lavage (BAL) fluid Gram's stain have been used to guide presumptive antibiotic therapy for ventilator-associated pneumonia (VAP) in injured patients, despite reported variability in sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Our aim was to evaluate the utility of Gram's stain of BAL fluid in the diagnosis of VAP. Methods: We conducted a retrospective chart review of all mechanically ventilated trauma patients who developed pneumonia over a 5-year period in whom Gram's stain and final culture data were available. Results: One hundred fifty-five records with complete data sets were reviewed. VAP was diagnosed by Centers for Disease Control and Prevention criteria and confirmed by BAL and quantitative culture in all patients. Overall accuracy of Gram's stain in diagnosing VAP for any organism was 88 {\%} (137 true-positives). When assessed for the ability to predict pneumonia caused by a specific organism, the accuracy decesased significantly, with only 63{\%} of Gram-negative VAPs and 72{\%} of Gram-positive VAPs accurately identified by Gram's stain. However, the absence of Gram-positive organism of Gram's stain excludes Gram-positive VAP in 80{\%} of patients. Conclusion: All trauma patients should be covered presumptively for gram-negative organisms, as they encompass 70{\%} of infections, but are not reliably identified by Gram's stain. As 88{\%} of VAP can be identified by the presence of any organism on Gram's stain, it may be useful in the early diagnosis of VAP but cannot reliably be used to guide presumptive therapy.",
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AU - Davis, Kimberly A.

AU - Eckert, Matthew J.

AU - Reed, R. Lawrence

AU - Esposito, Thomas J.

AU - Santaniello, John M.

AU - Poulakidas, Stathis

AU - Luchette, Fred A.

AU - Brasel, Karen

AU - Barie, Philip S.

AU - Malhotra, Ajai

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N2 - Background: The results of sputum or bronchoalveolar lavage (BAL) fluid Gram's stain have been used to guide presumptive antibiotic therapy for ventilator-associated pneumonia (VAP) in injured patients, despite reported variability in sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Our aim was to evaluate the utility of Gram's stain of BAL fluid in the diagnosis of VAP. Methods: We conducted a retrospective chart review of all mechanically ventilated trauma patients who developed pneumonia over a 5-year period in whom Gram's stain and final culture data were available. Results: One hundred fifty-five records with complete data sets were reviewed. VAP was diagnosed by Centers for Disease Control and Prevention criteria and confirmed by BAL and quantitative culture in all patients. Overall accuracy of Gram's stain in diagnosing VAP for any organism was 88 % (137 true-positives). When assessed for the ability to predict pneumonia caused by a specific organism, the accuracy decesased significantly, with only 63% of Gram-negative VAPs and 72% of Gram-positive VAPs accurately identified by Gram's stain. However, the absence of Gram-positive organism of Gram's stain excludes Gram-positive VAP in 80% of patients. Conclusion: All trauma patients should be covered presumptively for gram-negative organisms, as they encompass 70% of infections, but are not reliably identified by Gram's stain. As 88% of VAP can be identified by the presence of any organism on Gram's stain, it may be useful in the early diagnosis of VAP but cannot reliably be used to guide presumptive therapy.

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