Value Of Sputum Smear Gram Staining In The Early Diagnosis And Treatment Of Ventilator-associated Pneumonia

ObjectiveTo analysis the correlation between sputum smear and sputum culture and investigate the significance of sputum smear gram staining in the early diagnosis and antimicrobial treatment for ventilator-associated pneumonia (VAP) patients.MethodsFrom December2011to December2013, The Tianjin4th Central Hospital intensive care unit’s patients with ventilator-associated pneumonia were involved in investigating.The clinical diagnosis criteria of ventilator associated pneumonia refered to American Thoracic Society, Infectious Diseases Society of America, Guidelines for management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia(2005):new or progressive radiological pulmonary infiltrate plus>2of the following characteristics:temperature,>38.0℃or<36.0℃; leukocyte count,>10000cells/mm3or<4000cells/mm3; or purulent respiratory secretions, with the exception of pulmonary edema, ARDS, tuberculosis, pulmonary embolism and so on.The60ventilator-associated pneumonia patients were stratified to two groups. The target treatment group (group A) and empirical treatment group (group B), each group had30subjects separately. In group A, The choice of antibiotics was according to the result of sputum smear. However in group B, The choice of antibiotics was based on the following three factors:the time of VAP occur(early/late onset),the epidemiological bacteria of the ward and whether there are multidrug-resistant (MDR)bacteria pathogen infection risk factors. Sputum samples taken from lower respiratory tract were performed gram staining and culture, the pathogens were identified, results of two methods were compared.The levels of temperature,white blood cell, PCT and hs-CRP in the first day and third day were measured separately. Also compare the related complications and prognosis of the two groups.ResultsIn the first day the infections index had no statistical differences in the two groups(P>0.05).After the three days use of antibiotic, Compared with the empirical treatment group, the temperature,white blood cell, PCT and hs-CRP in the target treatment group was significantly lower(P<0.05);the antibiotic using strength was low, mechanical ventilation time and length of hospital stay was short, prognosis was better than experience treatment group, The difference had statistically significant(P <0.05).The sputum smear gram results had good correlation with sputum culture results.ConclusionsOptimized gram staining of the qualified sputum samples of lower respiratory tract is helpful in early diagnosis and treatment of VAP, it can reduced the antibiotic quantity, shorten the delays of ICU and improve the consequence of the patients. There was no significant difference between sputum smear gram staining and sputum culture. The result of the high qualified sputum smear has great significance to guide the first choice of antibiotic.