Trakealsekret

Indikationer

Pneumoni/nosokomial/ventilatorassocierad.

Provmaterial

Material som sugs genom tub eller trakeostomi.

Provtagning och transport

Trakealsug, art.nr. 12291. Obs! Ej bomullspinne.
Om förvaring oundviklig, +4oC.

Metoder

Mikroskopi

Kvantitativ odling.

Prov, som innehåller företrädesvis skivepitelceller, odlas ej.
Växt av minst 108 cfu/L signifikant, mindre besvaras "Ingen bakterieväxt".

Svarstid

3-7 dagar.

Kommentar

Metoden ger god korrelation med BAL och borstprov. Vid ventilatorpneumoni med <72 h intubering är S. pneumokocker, S. aureus och Haemophilus typiska fynd, vid senare debut ökar gram-stavar som Pseudomonas och Acinetobacter.

Referenser

Kallings I, Hallander H. Referensmetodik för kliniskt bakteriologiska laboratorier. I 2. Nedre luftvägsinfektioner. SBL-tryck, Stockholm 1991.

BSOP 3 Standard operating procedure: Investigation of bronchoalveolar lavage and associated specimens

Bergmans DC et al. Reproducibility of quantitative cultures of endotracheal aspirates from mechanically ventilated patientes. J Clin Microbiol 1996;35:796-798

Bonten MJ et al. Role of colonization of the upper intestinal tract in the pathogenesis of ventilator-associated pneumonia. Clin Infect Dis 1997;24:309-319

el-Ebiary M et al. Quantitative cultures of endotracheal aspirates for the diagnosis of ventilator-associated pneumonia. Am Rev Respir Dis 1993;148:1552-1557

Jourdain B et al. Role of quantitative cultures of endotracheal aspirates in the diagnosis of nosocomial pneumonia. Am J Respir Crit Care Med 1995;152:241-246

Kirtland SH et al. The diagnosis of ventilator-associated pneumonia. A comparison of histologic, microbiologic, and clinical criteria. Chest 1997;112:445-457

Koeman M et al. Ventilator-associated pneumonia: recent issues on pathogenesis, prevention and diagnosis. J Hosp Infect 2001;49:155-162

Marquette CH 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

Morris AJ et al. Rejection criteria for endotracheal aspirates from adults. J Clin Microbiol 1993;31:1027-1029

Niederman MS. Gram-negative colonization of the respiratory tract: pathogenesis and clinical consequences. Semin Respir Infect 1990;5:173-184

Ruiz M et al. Noninvasive versus invasive microbial investigation in ventilator-associated pneumonia. Am J Respir Crit Care Med 2000;162:119-125

Sanchez-Nieto JM et al. Impact of invasive and noninvasive quantitative culture sampling on the outcome of ventilator-associated pneumonia.  Am J Respir Crit Care Med 1998;157:371-376