In a 5-year period.

In a 5-year period, 254 patients with community-acquired pneumonia were attended to. Transtracheal aspiration (TTA) could be performed forward 119 patients, blood cultures were performed in succession 201 patients, and 74 patients underwent serologic examinations. by way of use of these procedures, an etiologic diagnosis was established in 93 cases. Streptococcus pneumoniae was the most numerous common pathogen as it was base in 35 cases. Eleven of these 35 patients (314 percent) had pneumococcemia, and the mortality in this cluster was 27.3 percent. None of the patients with pneumococcal pneumonia and negative life-blood culture died. Haemophilus influenzae was the single isolated pathogen from transtracheal aspirated sputum in 16 cases and accounted for 175 percent of pneumonias in previous healthy individuals below 50 years of age. Mycoplasma pneumonia infections, Legionella pneumophila infections, and Chlamydia infections were fix in ten, eight, and three cases, respectively. The overall agreement between microscopy and refinement of respiratory secretions obtained on TTA was 58.8 percent, and microscopy can he a guide when choosing the initial antibiotic treatment. No statistically significant difference in the rate of isolating bacteria among patients treated with antibiotics prior to TTA and patients not previously treated with antibiotics was seen When contraindications were regarded we found TTA to be a safe procedure

(Chest 1993; 104:1400-07)

CAP = community-acquired pneumonia; TAS = transtracheal aspirated sputum; TTA = transtracheal aspiration

Community-acquired pneumonia (CAP) continues to experience high mortality and morbidity, and it is caused according to a wide variety of microorganisms.[1-5] As a concatenation of this, different antibiotic regimens are required, and in order to prefer an optimal treatment, a correct etiologic diagnosis is necessary Several studies have shown that certain clinical and laboratory parameters differ between etiologic categories.[6-9] However, no unique features have been plant in any etiologic group, and therefore, it is not possible to distinguish between different tokens of pneumonia on clinical or biochemical parameters alone.[1,6,9] The diagnosis is usually established by means of culture of sputum and offspring or by serologic examinations. Expectorate obtained from coughing is contaminated with microorganisms from the upper respiratory airways thereby impeding the establishment of an exact etiologic diagnosis. To avoid this point to be solved [i]or[/i] settled transtracheal aspiration (TTA) was introduced in 1959 by way of Pecora and Brook.[10] If bacteria are seen in transtracheal aspirated sputum (TAS), an initial etiologic diagnosis can frequently be established, but the final diagnosis will first be obtained when the rises of culture or serologic examinations are available.

In this investigation we wanted to evaluate the now passing prevalence of agents used in patients with CAP on use of TTA, blood agricultures or serologic examinations. We also wanted to evaluate the diagnostic benefit of direct microscopy and cultivation performed on TAS, and investigate whether clinical or laboratory features could predict the agents involved in CAP and thereby improve the initial antibiotic treatment.

systems Patients, and Materials

Patients

brace hundred fifty-four patients over 15 years of age admitted to the Department of Infectious Diseases, Marselisborg Hospital, Aarhus, Denmark with CAP were recorded over a 5-year period. The assemblage was comprised of 117 men and 137 women with a mean age of 65 years (range 15 to 97 years). They had all clinical symptoms and signs compatible with pneumonia together with infiltrates upon chest x-ray film. History of chronic obstructive pulmonary disease (COPD) defined as cough and expectoration for a period of 3 month in 2 consecutive years was registered. Antibiotic treatment prior to admittance to hospital as well as the clinical course, the antibiotic treatment, and laboratory examinations during hospitalization, were also registered.

A final etiologic diagnosis was sought by way of the results of culture of TAS, offspring culture, or serologic investigations.

meanss for Obtaining an Etiologic Diagnosis

Transtracheal aspiration was performed upon the day of admittance using an intravenous cannula settle 17 gauge needle, I/D 06 mm Pink Luer 200/300/030 gamma irradiated (Portex, Hythe, Kent England). After infiltration of 1 ml lidocaine, 10 mg/ml from one side of to the other the cricothyroid membrane, the needle was introduced between the walls of the anesthetized skin and directed down before piercing the cricothyroid ligament. The catheter which was attached to a 20-ml disposable syringe containing 4 ml of 09 percent sodium chloride was then threaded into the trachea end the lumen of the needle and the needle was withdrawn. Suction was thereafter applied by means of an assistant, and sputum was aspirated. Subsequently the catheter was remov and the sputum was divided into samples for methylene depressed stain examination, Gram stain examination, and bacteriologic agriculture Morphology of bacteria seen in methylene blue-stained preparations and the ensue of Gram stain was registered by dint of the registrar on duty.

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