Character Of Sputum Research Articles

The radiologic findings, positivity rate of culture method examinations, correlation with the type of lower respiratory secretion of adult pulmonary Tuberculosis (TB) patients

Background: There are active and latent tuberculosis types, a global public health concern. Test confirmation is required to distinguish between active tuberculosis and nontuberculous mycobacterial infection. This study aims to evaluate the relationship between the type of lower airway secretion specimen, Mycobacterium tuberculosis positivity rate of MGIT-LJ, as well as the relationship between the Mycobacterium tuberculosis positivity rate in MGIT-LJ and radiological findings. Methods: This study is cross-sectional with a prospective design. The sample is the result of the examination of the MGIT-LJ method and medical record data of patients suspected of Pulmonary TB at Dr. Soetomo Academic Hospital Surabaya Indonesia that meets the inclusion criteria, analysis of the culture results of MGIT-LJ method and radiological findings were carried out to assess the relationship between the character of sputum, the positivity rate of Mycobacterium tuberculosis and radiological findings. Result: A total of 137 from June 2022 till November 2022 found 88 (64.2%) with spontaneous sputum, 6 (4,4%) aspirate ETT, and 43 (31.4%) BAL. The positivity rate of the MGIT-LJ culture method of the spontaneous sputum specimen to detect Mycobacterium tuberculosis was 20.5% higher than ETT or BAL specimens because the implementation of clinical indication to request MGIT-LJ culture method of ETT and BAL specimens is still confusing. The specificity of the chest radiography diagnostic test from all specimens type of 61.86%, with a weak accuracy rate. Conclusion: In this study, the positivity rate of the MGIT-LJ culture method of the spontaneous sputum specimen to detect Mycobacterium tuberculosis was 20.5% higher than ETT or BAL specimens. Chest radiography has a weak accuracy level and must be complemented test with the culture method.

Variability in Diagnosis and Treatment of Ventilator-Associated Pneumonia in Neurocritical Care Patients.

Clinical approach to ventilator-associated pneumonia (VAP) in the neurocritical care unit (NCCU) varies widely among physicians despite training and validated criteria. Prospective observational study of all mechanically ventilated patients with suspected VAP over 18months in an academic NCCU. Patients meeting VAP criteria by a surveillance program (SurvVAP) were compared to treated patients who did not meet surveillance criteria (ClinVAPonly). We identified appropriate/potentially inappropriate antibiotic treatment and factors associated with excessive antibiotic days (EAD). Of 622 ventilated patients, 83 cases were treated as VAP. Of these, 26 (31.3%) had VAP by CDC criteria (SurvVAP) (VAP rate=7.3 cases/1,000 ventilator days). Clinical features significantly more prevalent in SurvVAP cases (vs. ClinVAPonly) were change in sputum character, tachypnea, oxygen desaturation, persistent infiltrate on chest X-ray and higher clinical pulmonary infection score, but not positive sputum culture. Treatment with pneumonia-targeted antibiotics for >8days was significantly more common in ClinVAPonly versus SurvVAP patients (73.7 vs. 30.8%, p<0.001) even after excluding patients with other infections (p=0.001). Based on current guidelines, the ClinVAPonly group contributed 225 EAD, including 38 vancomycin days, 70 piperacillin-tazobactam days and 85 cephalosporin days with cost figure over four times that of EAD in SurvVAP group. No pre-specified factors were associated with continued VAP treatment beyond 8days. Incongruency between clinically and surveillance-defined VAP is common in acute neurological disease although outcomes did not differ between groups. Clinician behaviors rather than clinical factors may contribute to prolonged prescribing.

Prospective Study To Evaluate Mechanical Ventilator-Associated Pneumonia Rate in Intensive Care Units in a Peruvian Public Hospital: Benchmark with NNIS American Rates

OBJECTIVES: To measure the incidence of mechanical ventilator-associated pneumonia (VAP) in ICU in Peru and to compare with NNIS rates. METHODS: We performed a prospective nosocomial infection surveillance study during 3 months in one Peruvian ICUs of one public hospital. Nosocomial pneumonias were identified using the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance system (NNIS) definitions. Definitions: Criterion 1: A patient has rales or dullness to percussion on physical examination of the chest, and at least one of the following: new onset of purulent sputum or change in character of sputum; organism cultured from blood; isolation of an etiologic agent from a specimen obtained by trans-tracheal aspirate, bronchial brushing, or biopsy. Criterion 2: A patient has a chest radiographic examination that shows a new or progressive infiltrate, consolidation, cavitation, or pleural effusion and at least one of the following: new onset of purulent sputum or change in character of sputum; organism cultured from blood; isolation of an etiologic agent from a specimen obtained by transtracheal aspirate, bronchial brushing, or biopsy. VAP rate was calculated by dividing the number of associated pneumonias by the total number of device days. RESULTS: The VAP rate was 36.14 per 1000 device days (3/82) (benchmark with NNIS rate: 8.7 per 1000 ventilator days, RR: 4.18; CI 95% 1.35–12.97; p= 0.0070). CONCLUSION: When we compare with NNIS rates we found our VAP rate four times the NNIS rate. In Peruvian public hospitals we need to develop interventions to reduce nosocomial infections, especially VAP.

An assessment of the clinical efficacy in general practice of cefuroxime axetil when used in the management of unidentified infections of the lower respiratory tract

SummaryPatients aged 18‐65, presenting to their GP with an acute exacerbation of chronic obstructive airways disease (COAD) were entered into a therapeutic study of cefuroxime axetil 500 mg bd. Of those patients assessed, 87 per cent had a positive clinical response. All clinical signs and symptoms improved. Of those patients with a cough, 86 per cent had improved at Day 7, as had 75 per cent of those with shortness of breath. The quantity and character of sputum also improved consistently throughout the study. There was a significant improvement in peak flow results of 36 (SE 5) L/minute at the end of the study (p&lt; 0.001).Twenty‐six patients reported 36 adverse events, the most frequent being diarrhoea, in nine patients. No serious side effects occurred. Thus, cefuroxime axetil may be considered an appropriate antibiotic for use by GPs in these circumstances.

Acetylcysteine (Fabrol) in chronic bronchitis--a study in general practice.

The results of this general practice study suggest that acetylcysteine (Fabrol) administered orally for 2 months to patients with chronic bronchitis effectively changes the viscosity and character of sputum with resultant ease of expectoration and cough severity. There was a notable improvement in associated abnormal physical signs such as the presence of rhonchi, crepitations and symptoms including dyspnoea at rest. Tolerability was good, with 81% of patients experiencing no side-effects.

Broncho-Pulmonary Amoebiasis

SUMMARY A detailed analysis is given of a series of 28 cases with bronchopulmonary manifestations of amoebiasis. The series includes nine cases of pneumonitis, nine lung abscess, two bronchitis, four pleurisy with serous effusion and three empyema. Twenty two were secondary to spread from associated amoebic hepatitis or amoebic liver abscess and six were not accompanied by clinical evidence of disease in the liver and hence considered as examples of primary pulmonary amoebiasis. The commonest clinical manifestation of bronchopulmonary amoebiasis was pneumonitis or lung abscess of the lower zone of the right lung; hoemoptysis and localised chest pain were the most frequent presenting symptoms. Diagnosis was based on evidences obtained from history, right basal localisation of the lung lesion, character of sputum and associated liver condition and it was assured by the dramatic response to emetine hydrochloride. Working in an endemic locality, the physician should be amoebiasis conscious, when dealing with any right basal pneumonic lesion particularly if it is of a suppurative nature.