각종 폐질환에서 경기관흡입법(TTA)에 의한 세균검출에 관한 연구

Abstract

[한글]

상기도 및 구강내의 정상 세균총의 혼합없이 하부기도 염증의 원인균을 분리하기 위하여 경기관 흡입법(TTA)이 이용되고 있다. 저자는 각종 폐질환에서 TTA와 객담에 의한 세균검출의 결과를 비교하여 다음과 같은 결과를 얻었다.

TTA피검물의 직접도말을 gram염색한 결과는 객담보다는 세균배양의 그것과 더 잘 부합하였으며, TTA피검물은 상기도 정상 세균총의 혼합 배양의 가능성이 객담보다는 훨씬 적었다. 하부기도에 세균성 감염이 없었던 예들에서는 TTA를 실시한 전예에서 세균이 검출되지 않았다.

TTA시행후 환자의 18.2%에서 경미한 극소적인 합병증이 있었으나 1∼2일후 후유증 없이 회복되었다.

BACTERIOLOGICAL STUDIES ON THE VARIOUS PULMONARY DISEASES BY TRANSTRACHEAL

ASPIRATION

Chein Soo Hong

Dept. of Medical Science, The Graduate School, Yonsei University

(Directed by Professor Kiho Kim, M.D.)

The examination of expectorated sputum is not always a reliable indicator of the

organisms present in the lower respiratory tract because it is contaminated by

mouth flora. Some maneuvers designed to reduce the error have been introduced in

sampling of pulmonary secretions trough a bronchoscope, repeated washing of

expectorated sputum, and quantitative culture. These procedures cannot

differentiate organisms coming from the upper respiratory tract from those in the

lower respiratory tract.

In 1959 Pecora proposed transtracheal aspiration as a method of obtaining

material from the lower respiratory tract. Subsequent reports have confirmed the

safety and bacteriologic validity of this procedure.

The purpose of this report is to relate experience with this procedure of

transtracheal aspiration and the results of aerobic and anaerobic cultures in

patients with suspected infection in various pulmonary diseases.

1. Patients: Fifty-five patients who were admitted to Yonsei Medical Center

received transtracheal aspiration.

2. Method: A modification of the technique for transtracheal aspiration described

by Kalinske et al. in 1967 had been applied.

3. Bacteriological Method: Specimens obtained through transtracheal aspiration

were processed immediately after collection. Both specimens obtained through TTA

and expectorated sputum were examined by gram stain of direct smears and by culture

methods. The cultures were done for both aerobic and anaerobic bacteriae in the TTA

series, but only aerobic culture for expectorated sputum.

The results were as follow:

1. Bacterial culture of TTA specimens yielded no organisms in 81.7% out of 33

cases in which no organisms were found on direct gram stain. But bacterial cultures

of TTA specimens revealed organisms in 86.4% out of 22 cases in which organisms

were found on direct gram stain.

2. Potential pathogens were isolated in 80% out of 25 organism-identified

specimens by culture method of TTA, while only 22.6% out 53 organism-identified

specimens by culture of expectorated sputum were pathogenic.

Identical pathogens found both in the TTA specimens and in expectorated sputum

were isolated in only 5 cases.

3. No organisms have been isolated by TTA from patients with cardiovascular

disease with non-infectious pulmonary complications. Therefore, TTA will be of

benefit for the differential diagnosis between bacterial infections and

non-bacterial diseases when there is a pulmonary infiltration on a chest film.

4. Complications following TTA were noted in 10 cases(18.2%) and were

subcutaneous emphysema in 7 cases, hemoptysis in 3, local infection in 1, dyspnea

in 1 and dysphagia in 1.

But these complications were mild and transient, and also lasted only one or two

days.

[영문]

The examination of expectorated sputum is not always a reliable indicator of the organisms present in the lower respiratory tract because it is contaminated by mouth flora. Some maneuvers designed to reduce the error have been introduced in sampling of pulmonary secretions trough a bronchoscope, repeated washing of

expectorated sputum, and quantitative culture. These procedures cannot differentiate organisms coming from the upper respiratory tract from those in the lower respiratory tract.

In 1959 Pecora proposed transtracheal aspiration as a method of obtaining material from the lower respiratory tract. Subsequent reports have confirmed the safety and bacteriologic validity of this procedure.

The purpose of this report is to relate experience with this procedure of transtracheal aspiration and the results of aerobic and anaerobic cultures in patients with suspected infection in various pulmonary diseases.

1. Patients: Fifty-five patients who were admitted to Yonsei Medical Center received transtracheal aspiration.

2. Method: A modification of the technique for transtracheal aspiration described by Kalinske et al. in 1967 had been applied.

3. Bacteriological Method: Specimens obtained through transtracheal aspiration were processed immediately after collection. Both specimens obtained through TTA and expectorated sputum were examined by gram stain of direct smears and by culture methods. The cultures were done for both aerobic and anaerobic bacteriae in the TTA series, but only aerobic culture for expectorated sputum.

The results were as follow:

1. Bacterial culture of TTA specimens yielded no organisms in 81.7% out of 33 cases in which no organisms were found on direct gram stain. But bacterial cultures of TTA specimens revealed organisms in 86.4% out of 22 cases in which organisms were found on direct gram stain.

2. Potential pathogens were isolated in 80% out of 25 organism-identified specimens by culture method of TTA, while only 22.6% out 53 organism-identified specimens by culture of expectorated sputum were pathogenic.

Identical pathogens found both in the TTA specimens and in expectorated sputum were isolated in only 5 cases.

3. No organisms have been isolated by TTA from patients with cardiovascular disease with non-infectious pulmonary complications. Therefore, TTA will be of benefit for the differential diagnosis between bacterial infections and

non-bacterial diseases when there is a pulmonary infiltration on a chest film.

4. Complications following TTA were noted in 10 cases(18.2%) and were subcutaneous emphysema in 7 cases, hemoptysis in 3, local infection in 1, dyspnea in 1 and dysphagia in 1.

But these complications were mild and transient, and also lasted only one or two days.