Journal of Critical Care
Volume 23, Issue 1 , Pages 74-81 , March 2008

Utility of Gram stain in the clinical management of suspected ventilator-associated pneumonia: Secondary analysis of a multicenter randomized trial

  • M. Albert, MD

      Affiliations

    • Division of Critical Care, Department of Medicine, Université de Montréal, Montréal, Canada H3T 1J4
    • ,
  • J.O. Friedrich, MD, DPhil

      Affiliations

    • Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada M5B 1W8
    • ,
  • N.K.J. Adhikari, MDCM, MSc

      Affiliations

    • Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada M5B 1W8
    • ,
  • A.G. Day, MSc

      Affiliations

    • Clinical Research Centre, Kingston General Hospital, Kingston, Canada K7L 2V7
    • ,
  • C. Verdant, MD

      Affiliations

    • Division of Critical Care, Department of Medicine, Université de Montréal, Montréal, Canada H3T 1J4
    • ,
  • Daren K. Heyland, MD, MSc

      Affiliations

    • Department of Critical Care, Queens University, Kingston, Canada K7L 2V7
    • Corresponding Author InformationCorresponding author. Department of Medicine, Angada 4, Kingston General Hospital, Kingston, Ontario, Canada K7L 2V7. Tel.: +1 613 549 6666x3339; fax: +1 613 548 1351.
    • ,
  • for the Canadian Critical Care Trials Group

References 

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  2. Iregui M, Ward S, Sherman G, et al. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest. 2002;122:262–268
  3. Kollef M. Appropriate empirical antibacterial therapy for nosocomial infections: getting it right the first time. Drugs. 2003;63:2157–2168
  4. Neuhauser MM, Weinstein RA, Rydman R, et al. Antibiotic resistance among gram-negative bacilli in US intensive care units: implications for fluoroquinolone use. JAMA. 2003;289:885–888
  5. Allaouchiche B, Jaumain H, Chassard D, et al. Gram stain of bronchoalveolar lavage fluid in the early diagnosis of ventilator-associated pneumonia. Br J Anaesth. 1999;83:845–849
  6. Duflo F, Allaouchiche B, Debon R, et al. An evaluation of the Gram stain in protected bronchoalveolar lavage fluid for the early diagnosis of ventilator-associated pneumonia. Anesth Analg. 2001;92:442–447
  7. Blot F, Raynard B, Chachaty E, et al. Value of gram stain examination of lower respiratory tract secretions for early diagnosis of nosocomial pneumonia. Am J Respir Crit Care Med. 2000;162:1731–1737
  8. Sirvent JM, Vidaur L, Gonzalez S, et al. Microscopic examination of intracellular organisms in protected bronchoalveolar mini-lavage fluid for the diagnosis of ventilator-associated pneumonia. Chest. 2003;123:518–523
  9. Allaouchiche B, Jaumain H, Dumontet C, et al. Early diagnosis of ventilator-associated pneumonia. Is it possible to define a cutoff value of infected cells in BAL fluid?. Chest. 1996;110:1558–1565
  10. Heyland D, Dodek P, Muscedere J, et al. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med. 2006;355:2619–2630
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  12. Brun-Buisson C, Fartoukh M, Lechapt E, et al. Contribution of blinded, protected quantitative specimens to the diagnostic and therapeutic management of ventilator-associated pneumonia. Chest. 2005;128:533–544
  13. Veinstein A, Brun-Buisson C, Derrode N, et al. Validation of an algorithm based on direct examination of specimens in suspected ventilator-associated pneumonia. Intensive Care Med. 2006;
  14. Fagon JY, Chastre J, Wolff M, et al. Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia. A randomized trial. Ann Intern Med. 2000;132:621–630
  15. Croce MA, Fabian TC, Waddle-Smith L, et al. Utility of Gram's stain and efficacy of quantitative cultures for posttraumatic pneumonia: a prospective study. Ann Surg. 1998;227:743–751discussion 751-45
  16. Davis KA, Eckert MJ, Reed RL, et al. Ventilator-associated pneumonia in injured patients: do you trust your Gram's stain?. J Trauma. 2005;58:462–466discussion 466-67
  17. 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
  18. Marquette CH, Copin MC, Wallet F, et al. Diagnostic tests for pneumonia in ventilated patients: prospective evaluation of diagnostic accuracy using histology as a diagnostic gold standard. Am J Respir Crit Care Med. 1995;151:1878–1888
  19. Prekates A, Nanas S, Argyropoulou A, et al. The diagnostic value of gram stain of bronchoalveolar lavage samples in patients with suspected ventilator-associated pneumonia. Scand J Infect Dis. 1998;30:43–47
  20. 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
  21. Wahl WL, Ahrns KS, Brandt MM, et al. Bronchoalveolar lavage in diagnosis of ventilator-associated pneumonia in patients with burns. J Burn Care Rehabil. 2005;26:57–61
  22. Steinberg MAM, Parkes R, Ferguson ND, Rizoli SB, McLeod RS, Marshall JC Canadian Critical Care Trials Group. Empiric antimicrobial therapy for suspected ICU-acquired infection: The AATIC pilot study. Intensive Care Med. 2006;32:113
  23. Baker AMMJ, Chang M, Dunagan D, Smith A, Haponik E. Bronchoscopically guided management of ventilator-associated pneumonia in trauma patients. J Bronchol. 2003;10:7–16

☆ Supported by grants from the Canadian Institutes of Health Research and Physicians' Services, Inc, of Ontario, and by unrestricted grants from AstraZeneca and Bayer.

PII: S0883-9441(08)00010-5

doi: 10.1016/j.jcrc.2008.01.004

Journal of Critical Care
Volume 23, Issue 1 , Pages 74-81 , March 2008

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