Routine Sputum Culture Research Articles

Sputum bacteriology in patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease and concomitant pneumonia in Hong Kong

To study the sputum microbiology of patients admitted to a teaching hospital with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with concomitant pneumonia. This was a retrospective study in a tertiary university hospital in Hong Kong. All episodes of AECOPD with pneumonia, patient demographics, length of stay, sputum culture and radiological results admitted in the first half of the year 2000 were retrieved from hospital records. There were 118 patients (91 male) with 150 episodes of AECOPD with concomitant pneumonia. The age of the patients was 74.8 +/- 10.0 years. Positive routine sputum culture was detected in 45.6% of the patients. Among these hospital admissions, 8.7, 4.0 and 12.0%, respectively, required intensive care unit admissions, mechanical ventilation and non-invasive positive pressure ventilation. Haemophilus influenzae was the commonest organism found in sputum (26.0%), followed by Pseudomonas aeruginosa (5.5%), Streptococcus pneumoniae (3.4%), and Moraxella catarrhalis (3.4%). Mycobacterium tuberculosis was found in 1.5% of the admissions. The presence of P. aeruginosa in sputum was associated with a longer hospital length of stay (9.1 +/- 3.1 vs. 7.1 +/- 4.2 days, P = 0.03). In contrast to most other studies reporting S. pneumoniae as the most likely bacterial pathogen, H. influenzae was the commonest bacterium isolated in sputum in our patients with AECOPD and concomitant pneumonia.

Routine Sputum Culture of Questionable Value in Community-Acquired Pneumonia

Recent study findings and professional guidelines have challenged the practice of using sputum Gram stain and culture to make decisions about antibiotic use for community-acquired pneumonia (CAP). To assess the value of sputum collection relative to CAP severity, researchers in Spain studied 1669 consecutive patients with evidence …

Community-Acquired Pneumonia

We initiated a prospective study with a group of practitioners to assess the etiology, clinical presentation, and outcome of community-acquired pneumonia in patients diagnosed in the outpatient setting. All patients with signs and symptoms suggestive of pneumonia and an infiltrate on chest X-ray underwent an extensive standard workup and were followed over 4 weeks. Over a 4-year period, 184 patients were eligible, of whom 170 (age range, 15-96 yr; median, 43 yr) were included and analyzed. In 78 (46%), no etiologic agent could be demonstrated. In the remaining 92 patients, 107 etiologic agents were implicated: 43 were due to "pyogenic" bacteria (39 Streptococcus pneumoniae, 3 Haemophilus spp., 1 Streptococcus spp.), 39 were due to "atypical" bacteria (24 Mycoplasma pneumoniae, 9 Chlamydia pneumoniae, 4 Coxiella burnetii, 2 Legionella spp.), and 25 were due to viruses (20 influenza viruses and 5 other respiratory viruses). There were only a few statistically significant clinical differences between the different etiologic categories (higher age and comorbidities in viral or in episodes of undetermined etiology, higher neutrophil counts in "pyogenic" episodes, more frequent bilateral and interstitial infiltrates in viral episodes). There were 2 deaths, both in patients with advanced age (83 and 86 years old), and several comorbidities. Only 14 patients (8.2%) required hospitalization. In 6 patients (3.4%), the pneumonia episode uncovered a local neoplasia. This study shows that most cases of community-acquired pneumonia have a favorable outcome and can be successfully managed in an outpatient setting. Moreover, in the absence of rapid and reliable clinical or laboratory tests to establish a definite etiologic diagnosis at presentation, the spectrum of the etiologic agents suggest that initial antibiotic therapy should cover both S. pneumoniae and atypical bacteria, as well as possible influenza viruses during the epidemic season.

Prospective Study of the Immunologic Factors Affecting the Prognosis of Severe Community-Acquired Pneumonia

Background : In the severe community-acquired pneumonia, it has been known that the immune status is occasionally suppressed. This study was performed to identify the immunologic markers related with the prognostic factors in severe community-acquired pneumonia. Methods : 23 patients with severe community-acquired pneumonia were involved in this study, and divided into survivor (16) and nonsurvivor (7) groups. In this study, the medical history, laboratory tests(complete blood counts, routine chemistry profile, immunoglobulins, complements, lymphocyte subsets, cytokines, sputum and blood culture, urine analysis), and chest radiographs were scrutinized. Results : 1) Both groups had lymphopenia(total lymphocyte count in the survivor and in the nonsurvivor group). 2) The T-lymphocyte count of the nonsurvivor group() was lower than the survivor group() (p in the survivor and in the nonsurvivor group. The BUN of the nonsurvivor group() was higher than that of the survivor group()(p) than that in the survivor group()(p) than in the nonsurvivor group() (p level was in the survivor group and in the nonsurvivor group. 6) A cytokine study showed an insignificant difference in both groups. 7) Chronic liver disease, DM, and COPD were major underlying diseases in both groups. Conclusion : These results suggest that decreased a T-lymphocyte count and immunoglobulin G level, and an increased BUN and creatinine level may be associated with the poor prognosis of severe community-acquired pneumonia.

Aetiology, outcome, and risk factors for mortality among adults with acute pneumonia in Kenya

Despite a substantial disease burden, there is little descriptive epidemiology of acute pneumonia in sub-Saharan Africa. We did this study to define the aetiology of acute pneumonia, to estimate mortality at convalescence, and to analyse mortality risk-factors. We studied 281 Kenyan adults who presented to two public hospitals (one urban and one rural) with acute radiologically confirmed pneumonia during 1994-96. We did blood and lung-aspirate cultures, mycobacterial cultures, serotype-specific pneumococcal antigen detection, and serology for viral and atypical agents. Aetiology was defined in 182 (65%) patients. Streptococcus pneumoniae was the most common causative agent, being found in 129 (46%) cases; Mycobacterium tuberculosis was found in 26 (9%). Of 255 patients followed up for at least 3 weeks, 25 (10%) died at a median age of 33 years. In multivariate analyses, risk or protective factors for mortality were age (odds ratio 1.51 per decade [95% CI 1.04-2.19]), unemployment (4.42 [1.21-16.1]), visiting a traditional healer (5.26 [1.67-16.5]), visiting a pharmacy (0.30 [0.10-0.91]), heart rate (1.64 per 10 beats [1.24-2.16]), and herpes labialis (15.4 [2.22-107]). HIV-1 seropositivity, found in 52%, was not associated with mortality. Death or failure to recover after 3 weeks was more common in patients with pneumococci of intermediate resistance to benzylpenicillin, which comprised 28% of pneumococcal isolates, than in those infected with susceptible pneumococci (5.60 [1.33-23.6]). We suggest that tuberculosis is a sufficiently common cause of acute pneumonia in Kenyan adults to justify routine sputum culture, and that treatment with benzylpenicillin remains appropriate for clinical failure due to M. tuberculosis, intermediate-resistant pneumococci, and other bacterial pathogens. However, interventions restricted to hospital management will fail to decrease mortality associated with socioeconomic, educational, and behavioural factors.

Bacteriologic diagnosis of respiratory tract infection

The use of the Gram stain for determination of the presence of bacteria in respiratory secretions is described. Success of the procedure depends on the use of fresh samples of high cellular quality. The Gram stain can be used to distinguish the presence (among other organisms) of Streptococcus pneumoniae, Haemophilus influenzae, Branhamella catarrhalis enterobacteria and Pseudomonas. This paper also discusses the use of sputum samples for bacteriologic culture and the value of bacterial counts in expectorated sputum, and describes the use of transtracheal aspiration and transthoracic aspiration puncture. Finally, it considers the optimum procedures for the testing of antibiotic susceptibility of presumptive pathogens isolated from the lower respiratory tract.

Acute renal failure in fulminant psittacosis

A previously fit 68-year-old man was admitted with a history of an upper respiratory infection a week previously, followed after 72 h by rapidly progressive breathlessness, malaise and fever. There was no history of chest pain, sputum or haemoptysis and be denied previous respiratory symptoms. He was a non-smoker. On admission he was ill, with fever (399~ tachypnoea with wheeze, and central cyanosis. He was in rapid atrial fibrillation; blood pressure was 200/120. Widespread wheezes and basal crackles were present, and the chest X-ray showed bilateral patchy shadowing in the midzones. Arterial gases (on air): pH 7-49, PaCO 2 376 kPa, PaO 2 5.14 kPa, 0 2 saturation 78-2%. Other investigations: Hb 161 g d1-1, WBC 12.2 x 1091 1 (89% neutrophils), platelets 164x 1091 1, serum urea 15.6 mmol1-1, creatinine 185 #mol l 1, sodium 133 mmol 1 2, potassium 37 mmol 1 1, the urine was sterile and showed 40 red cells/A 1 but no white cells. Routine blood and sputum cultures (excluding Legionella pneumophila) were negative. He was treated initially with intravenous erythromycin 1 g q.d.s. (with the addition of flucloxacillin 500 mg q.d.s, intravenously after 24 h), nebulized bronchodilators and high concentration oxygen therapy by mask, but deteriorated with increasing respiratory failure, mental confusion

Nosocomial pneumonia: pathogenesis, diagnosis, current therapy and prophylactic approach

Pneumonia is the second most common hospital-acquired infection, occurring more frequently in mechanically-ventilated patients, and is the leading cause of death from nosocomial infections. Pathogenesis is linked with oropharyngeal flora aspiration when colonized with Gram-negative organisms either directly from the environment or retrogradely from the stomach whenever the pH is > 4. The main pathogens implicated are Enterobacteriaceae and Pseudomonas aeruginosa. Routine sputum cultures are unreliable because of contamination with oropharyngeal flora; however, a bronchoscopic protected specimen brush and bronchoalveolar lavage techniques may overcome this problem. A combination of broad-spectrum antibiotics and monotherapy with newer antimicrobial agents appear to be equally effective in treatment of nosocomial infections. The efficacy of prophylaxis after selective gut decontamination in intensive care unit patients, however, has not yet been established.

Prevention of chronic Pseudomonas aeruginosa colonisation in cystic fibrosis by early treatment

To assess whether chronic pulmonary colonisation with Pseudomonas aeruginosa in cystic fibrosis is preventable, 26 patients who had never received anti-pseudomonas chemotherapy were randomly allocated to groups receiving either no anti-pseudomonas chemotherapy or oral ciprofloxacin and aerosol inhalations of colistin twice daily for 3 weeks, whenever Ps aeruginosa was isolated from routine sputum cultures. During the 27 months of the trial, infection with Ps aeruginosa became chronic in significantly fewer treated than untreated subjects (2 [14%] vs 7 [58%]; p<0·05) and there were significantly fewer Ps aeruginosa isolates in routine sputum cultures in the treated group (49/214 [23%] vs 64/158 [41%]; p=0·0006). Thus, chronic colonisation with Ps aeruginosa can be prevented in cystic fibrosis by early institution of anti-pseudomonas chemotherapy.

The Influence Of Patient Location and Physician on Sputum Adequacy in a Veterans Administration Medical Center

Routine bacterial sputum culture results from September 1987 through August 1988 were reviewed to determine the relationship of patient location and physician on specimen adequacy. Specimens from patients in intensive care units (ICUs) were more likely to be good than those from other hospital wards. In addition, when physicians were rotating in ICUs, the quality of sputa from their patients was significantly better than when the same physicians were rotating in non-ICUs. As a single factor, patient location (ie, ICU vs non-ICU) is more important than physician in determining the quality of sputum for culture. However, there is no doubt that physician ordering practices and demands for proper specimen collection are also very important factors.

The significance of Branhamella catarrhalis in bronchopulmonary infection — A case-control study

Data, including clinical features of bronchopulmonary infections, i.e. cough with purulent sputum, fever, peripheral blood leucocytosis, patchy pulmonary shadows on chest radiographs and the presence of crepitations or dullness on examination of the chest, were prospectively recorded in 107 consecutive adult patients whose expectorated sputum yielded Branhamella-like bacterial colonies in routine cultures. Subsequently, isolates from 26 patients were confirmed to be Branhamella catarrhalis. Of 81 patients (unmatched controls) with confirmed commensal Neisseria species, 40 (matched controls) were age and sex matched with the 26 patients (cases) positive for B. catarrhalis. Clinical features of bronchopulmonary infection were significantly more among cases compared to unmatched controls. Compared with matched controls, significantly more of the cases had three or more clinical features of bronchopulmonary infection (P less than 0.05). This is the first study of the clinical significance of B. catarrhalis in expectorated sputum that included controls to circumvent the confounding effects of oropharyngeal and airway colonisation in patients with bronchopulmonary infections. The isolation of this organism in routine sputum culture was found to be significantly related to clinical infection.

Screening for legionnaires' disease by routine sputum culture and its serology

Screening for legionnaires' disease by routine sputum culture and its serology

Clinching the diagnosis - sputum and other specimens in respiratory tract infection

Routine sputum culture in microbiology laboratories is frequently a source of dissatisfaction to microbiologists and clinicians alike. Care should be taken to ensure that the investigations requested are appropriate and that an adequate specimen is collected. Co-operation between the microbiologist and the clinician is required if the laboratory's facilities are to be properly exploited for the etiological diagnosis of respiratory tract infection. In clinical conditions such as lung abscess and atypical pneumonia sputum is not an appropriate specimen for the laboratory to work on and early consideration should be given to obtaining lower respiratory tract secretions free of oropharyngeal contamination.

Mycobacteria on Routine Sputum Culture Plates: A Potential for Laboratory-Acquired Infection

Mycobacteria on Routine Sputum Culture Plates: A Potential for Laboratory-Acquired Infection

793 EVALUATION OF QUANTITATIVE CULTURES OF SPUTUM FROM CHILDREN WITH CYSTIC FIBROSIS

Eighty-three sputa were obtained from 41 children with cystic fibrosis and maintained on ice until culture within 20 minutes. Quantitative cultures (QNC) were made by inoculating serial 10-fold dilutions of the sputum, homogenized with N-acetyl cysteine, onto blood, chocolate, and eosin methylene blue agar plates. The same sputum samples were then cultured qualitatively (QLC) on the same types of agar. An average of 3.9 bacterial species per sample in a concentration of ≥ 104 CFU/ml were recovered by QNC. Organisms which might be considered “normal flora” were recovered from 57 QNC and 80 QLC. Potential pathogens were recovered from 80 QNC and from 74 QLC. S. aureus, present in QNC in a mean concentration of 3.2 × 107/ml, was recovered from 31 sputum pairs and additionally from 1 QNC and 2 QLC. Ps. aeruginosa, present in QNC in an average concentration of 1.9 × 108/ml,was recovered by both methods 55 times, 3 additional times each by QNC and QLC. H. influenzae was present in QNC in a mean concentration of 3.4 × 108/ml and was recovered by both culture techniques 9 times. It was recovered 26 additional times by QNC and 2 additional times by QLC. In 24 of 24 instances, the H. influenzae recovered by QNC was not typable by counter immunoelectropheresis. Routine qualitative sputum cultures underestimate the frequency with which H. influenzae may be recovered from children with cystic fibrosis.

The risk of positive cultures for Candida in the critically ill patient.

It is frequently stated that a positive fungal culture is of little clinical significance unless the culture is obtained on repetitive blood specimens. We analyzed the mortality associated with a positive culture for Candida species in ICU patients from several locations over a 3-month period. Criteria for inclusion in this study were: (1) residence in the ICU for at least 4 days, (2) no GI tract alimentation during this period, and (3) administration of at least one antibiotic during this period. Forty-four patients fit these criteria; 23 had positive Candida cultures from at least one site and 12 (52%) died. Four of 21 patients (19%) who did not grow Candida died. Cultures of urine and sputum were most likely to be positive. Positive cultures from the urine, sputum, or wound were associated with at least a 50% mortality. This suggests that routine sputum and urine cultures may be of substantial clinical therapeutic and prognostic significance. Two patients had positive blood cultures and both died. No single class of antibiotics, surgical complications or underlying disease predisposed to these results. It is concluded that the presence of a single positive culture for Candida from any site in the critically ill surgical patient kept without GI alimentation and on any antibiotic is a grave prognostic sign which requires further attention.

Idiopathic pulmonary hemorrhage with hemosiderosis and microcytic anemia.

The radiologist is in a position to make a significant contribution to the explanation of hemoptysis in some patients if he is aware of the characteristic pattern of idiopathic pulmonary hemorrhage. In Europe the condition has been called the Ceelen-Gellerstedt syndrome; in the United States it has most frequently been described as idiopathic pulmonary hemosiderosis. The first description of the pathologic findings was made by Virchow more than a century ago. Ceelen reported on the autopsies of 2 cases in 1921 (5). Waldenstrom in 1938 correlated the clinical with the pathological picture (12). Recently the reports have been more numerous, and at present approximately 60 cases have been described, most of them with autopsy documentation. According to these reports, the disease usually is fatal within a few years. However, several patients have been reported as being alive several years after the diagnosis was made (2, 7, 9). Case Report M. C. S., a 9-year-old white girl, was admitted to Babies and Childrens Hospital on March 25, 1953, because of expectoration of small amounts of blood-streaked sputum for three or four days. For several months before admission she had been experiencing low-grade fever with frequent respiratory infections, for which she had been treated repeatedly with sulfonamides and antibiotics. A chest roentgenogram made elsewhere two months previously was reported to be normal. The admission rectal temperature was 37.6° C, pulse 120, respirations 24. The patient appeared pale but not acutely ill. The physical examination, including the heart and lungs, was otherwise normal. The blood showed a hemoglobin of 8.6 gm. per cent, a hematocrit of 30 per cent, and 0.4 per cent reticulocytes. The white count was 4,100, with a normal differential, including 2 per cent eosinophils. Other laboratory tests, including sedimentation rate, cold agglutinins, febrile agglutinins, heterophil reaction, tuberculin reactions, bleeding and clotting times, serum proteins, stool guaiac examinations, and routine sputum cultures, gave normal results. No acid-fast bacilli were found in the sputum. The postero-anterior chest roentgenogram showed streaky and mottled fine densities, diffusely distributed throughout the lungs, but with a tendency to coalescence (Fig. 1). During one week in the hospital the course was mildly febrile (maximum temperature 38° C.) and slight hemoptysis continued. One unit of whole blood was given, and the patient was discharged with a hemoglobin of 11.2 gm. per cent and hematocrit of 35 per cent. A few days later the child was readmitted for bronchoscopy and bronchography. Both studies were normal. A postero-anterior roentgenogram obtained nineteen days after the original examination revealed a marked degree of improvement (Fig. 2). A third admission occurred on June 29, 1953, following another episode of hemoptysis and fever.