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Abstract
BackgroundLower respiratory tract infection (LRIs) is very common both in terms of community-acquired infection and hospital-acquired infection. Sputum and bronchoalveolar lavage fluid (BALF) are the most important specimens obtained from patients with LRI. The choice of antibiotic with which to treat LRI usually depends on the antimicrobial sensitivity of bacteria isolated from sputum and BALF. However, differences in the antimicrobial sensitivity of pathogens isolated from sputum and BALF have not been evaluated.MethodsA retrospective study was conducted to analyze the differences between sputum and BALF samples in terms of pathogen isolation and antimicrobial sensitivity in hospitalized patients with LRI.ResultsBetween 2013 and 2015, quality evaluation of sputum samples was not conducted before performing sputum culture; however, between 2016 and 2018, quality evaluation of sputum samples was conducted first, and only quality-assured samples were cultured. The numbers of sputum and BALF in 2013–2015 were 15,549 and 1671, while those in 2016–2018 were 12,055 and 3735, respectively. The results of pathogen culture showed that Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus, Hemophilus influenzae, Escherichia coli, Stenotrophomonas maltophilia, and Streptococcus pneumoniae were in the top ten pathogens isolated from sputum and BALF. An antimicrobial susceptibility test showed that the susceptibility of BALF isolates to most antibiotics was higher compared with the susceptibility of sputum isolates, especially after quality control of sputum samples (2016–2018).ConclusionsOur findings suggest that caution is needed in making therapeutic choices for patients with LRI when using antimicrobial sensitivity results from sputum isolates as opposed to BALF isolates.
Highlights
Lower respiratory tract infection (LRIs) is very common both in terms of community-acquired infection and hospital-acquired infection
In 2013–2015 and 2016–2018, Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus, Hemophilus influenzae, Escherichia coli, Stenotrophomonas maltophilia, and Streptococcus pneumoniae were in the top ten pathogens isolated from sputum and bronchoalveolar lavage fluid (BALF) (Fig. 1)
In 2013–2015, the sensitivity rates of P. aeruginosa in BALF to commonly used antibiotics were higher compared with sputum isolates, with the exception of ciprofloxacin and levofloxacin
Summary
Lower respiratory tract infection (LRIs) is very common both in terms of community-acquired infection and hospital-acquired infection. The choice of antibiotic with which to treat LRI usually depends on the antimicrobial sensitivity of bacteria isolated from sputum and BALF. According to data from China Antimicrobial Resistance Surveillance System in 2015, the major specimen obtained from inpatients who attended respiratory departments in China was sputum (81.6%, 41,131/50,417) [1, 2]. Sputum specimens are affected by oral colonization flora; it is difficult to judge whether sputum culture isolates are indicative of infection, colonization or contamination. Because of this, it is difficult for clinicians and laboratory physicians to evaluate the significance of sputum culture results
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