Sputum Culture In Patients Research Articles

Community-Acquired Pneumonia for the Hospitalist: Updates and Controversies

The American Thoracic Society (ATS)/Infectious Disease Society of American (IDSA) guidelines for the diagnosis and treatment of community-acquired pneumonia (CAP) were released in 2019. While most categories had minor updates, one major change was abandonment of the term “healthcare-associated pneumonia” (HCAP). The guidelines also recommended against use of procalcitonin for the decision to initiate antibiotics; recommended against use of corticosteroids in all cases but pneumonia with septic shock; and recommended obtaining blood and sputum cultures in patients with pneumonia at risk for methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa. This review will cover studies published since the 2019 guidelines that help answer unaddressed questions and/or add clarity to areas of uncertainty.

EPS9.02 Pseudomonas aeruginosa in sputum cultures of patients with cystic fibrosis before and during one year of elexacaftor/tezacaftor/ivacaftor

EPS9.02 Pseudomonas aeruginosa in sputum cultures of patients with cystic fibrosis before and during one year of elexacaftor/tezacaftor/ivacaftor

Persistence and genetic adaptation of Pseudomonas aeruginosa in patients with chronic obstructive pulmonary disease

ObjectivesIt is unclear whether recurrent sputum culture with Pseudomonas aeruginosa from patients with chronic obstructive pulmonary disease (COPD) is caused by intermittent airway carriage by different P. aeruginosa lineages or persistent carriage by the same lineage, and whether lineages genetically adapt during carriage. MethodsWhole-genome sequencing was performed for P. aeruginosa isolates sampled longitudinally from sputum cultures in patients with COPD who were enrolled in an ongoing randomized controlled trial (clinicaltrials.gov: NCT03262142). ResultsA total of 153 P. aeruginosa isolates were sequenced for 23 patients during 365 days of follow-up. Recurrent presence of P. aeruginosa was seen in 19 patients (83%) and was caused by persistence of the same clonal lineage in all but one patient. We identified 38 genes mutated in parallel in two or more lineages, suggesting positive selection for adaptive mutations. Mutational enrichment analysis revealed genes important in antibiotic resistance and chronic infections to be more frequently mutated. DiscussionRecurrent P. aeruginosa was common and carried for a prolonged time after initial detection in the airways of patients with COPD. Recurrence was caused by persistence of the same clonal lineage and was associated with genetic adaptation. Trial data on possible clinical benefits of attempting antibiotic eradication of P. aeruginosa in COPD are warranted.

Impact of global budget combined with pay-for-performance on the quality of care in county hospitals: a difference-in-differences study design with a propensity-score-matched control group using data from Guizhou province, China

BackgroundProvider payment system has a profound impact on health system performance. In 2016, a number of counties in rural Guizhou, China, implemented global budget (GB) for county hospitals with quality control measures. The aim of this study is to measure the impact of GB combined with pay-for-performance on the quality of care of inpatients in county-level hospitals in China.MethodsInpatient cases of four diseases, including pneumonia, chronic asthma, acute myocardial infarction and stroke, from 16 county-level hospitals in Guizhou province that implemented GB in 2016 were selected as the intervention group, and similar inpatient cases from 10 county-level hospitals that still implemented fee-for-services were used as the control group. Propensity matching score (PSM) was used for data matching to control for age factors, and difference-in-differences (DID) models were constructed using the matched samples to perform regression analysis on quality of care for the four diseases.ResultsAfter the implementation of GB, rate of sputum culture in patients with pneumonia, rate of aspirin at discharge, rate of discharge with β-blocker and rate of smoking cessation advice in patients with acute myocardial infarction increased. Rate of oxygenation index assessment in patient with chronic asthma decreased 20.3%. There are no significant changes in other indicators of process quality.ConclusionsThe inclusion of pay-for-performance in the global budget payment system will help to reduce the quality risks associated with the reform of the payment system and improve the quality of care. Future reform should also consider the inclusion of the pay-for-performance mechanism.

Diagnostic yield of bacteriological tests and predictors of severe outcome in adult patients with COVID-19 presenting to the emergency department

BackgroundGuidelines recommend maximal efforts to obtain blood and sputum cultures in patients with COVID-19, as bacterial coinfection is associated with worse outcomes. The aim of this study was to evaluate...

Clinical implications of fungal isolation from sputum in adult patients with cystic fibrosis

Cystic fibrosis is an autosomal recessive disease with a defect in mucociliary activity that is characterized by recurrent pulmonary infections. Bacterial agents frequently implicated in airway colonization are Haemophilus influenzae, Staphylococcus spp., and Pseudomonas spp. Fungal isolation from sputum is common in adults. However, growth of fungal agent only in sputum culture in patients with cystic fibrosis is insufficient for the diagnosis of fungal diseases. There is limited data about the clinical significance of fungal isolation in sputum cultures. The aim of the study was to investigate the clinical outcomes andsignificance of fungal isolation from sputum samples in adult CF. This retrospective study included patients who have been admitted between October 2017 and January 2019 in an adult cystic fibrosis unit. Patients were grouped according to fungal pathogenicity as; fungal disease group, colonization group, and nonisolated group. The data of the last one year, including demographics, clinical data, laboratory, treatment modalities, results of cultured bacteria and fungus from sputum samples, respiratory function parameters, frequency of exacerbation, and hospitalizationwere compared between groups. A total of 330 sputum samples from 88 adult patients with CF were collected. Patients were divided into 3 groups, the fungal disease group (n = 10, 11.4%), colonization group (n = 49, 55.7%), and nonisolated group (n = 29, 32.9%). Presence of pulmonary exacerbation, number of admissions to emergency department, and the number of positive cultures for bacteria from sputum were higher in the fungal disease group (p = 0.03, p = 0.01 and p < 0.001). The fungal disease group had higher rate of antibiotics by parenteral routethan other groups (p = 0.001) whereas lung functions were similar. Use of nutritional supplementation and parenteral antibiotherapy were the factors associated with elevated risk of fungal isolation. Frequent use of parenteral antibiotics and use of nutritional supplementation were found to be independent risk factors for fungal isolation from sputum in adult CF.

Severe Pneumonia: Etiology and Outcome in a Tertiary Hospital in Indonesia

Background: Severe pneumonia represents a subset of life-threatening pneumonia. The mortality rate ofpatients with severe pneumonia is considerably high. This study aims to determine the etiology and outcomeof severe pneumonia.Methods: An observational prospective study was conducted from September 2017 to September 2018 onpneumonia patients in a tertiary hospital. Clinical and diagnostic evaluations were carried out to assess theseverity of the disease, etiology, comorbidities, and several other factors associated with outcomes.Results: 140 pneumonia patients were evaluated and 41 patients met the severe pneumonia criteria. Apathogen was found in 20 community-acquired pneumonia (CAP) and 13 hospital-acquired pneumonia(HAP). The most frequently isolated pathogen from the sputum culture of patients with either severe CAPor HAP was Acinetobacter baumannii. The mortality rate of severe HAP patients was higher than thatof severe CAP patients (84% vs. 65%), but the difference was nonsignificant. Most of the subjects hadcomorbidities (CAP 75%, HAP 61.6%). Procalcitonin (PCT) and C-reactive protein (CRP) levels in severeCAP were higher than those in severe HAP (PCT 7.7 vs 6.0, p=0.658; CRP 163.1 vs 93.6, p=0.580), but thedifferences were also nonsignificant.Conclusion: The most frequently isolated pathogens from the sputum culture of patients with severepneumonia were Acinetobacter baumanii, which should be considered at the time of diagnosis and empiricalantibiotic therapy. Severe pneumonia was often accompanied by comorbidities, inflammation responsesincrease in both severe CAP and HAP with a high mortality rate.

1476. Impact of an Educational Campaign on Rates of Sputum Culture Acquisition as an Opportunity for Antibiotic De-escalation

BackgroundThe 2019 community-acquired pneumonia (CAP) guidelines recommend obtaining a sputum culture in patients who are empirically treated for methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa to assist clinicians in optimizing antimicrobial therapy. A previous study at our institution found respiratory cultures were rarely obtained in patients with CAP. As a result of these findings, an educational campaign was implemented to promote the use of an induced sputum protocol.MethodsThis was a multicenter, retrospective cohort study that included patients who were ≥18 years of age, had a diagnosis of CAP, and received ≥48 hours of anti-pseudomonal antibiotics. Patients were excluded if mechanically ventilated within 48 hours of admission or diagnosed with hospital-acquired or ventilator-associated pneumonia. Patients were grouped into pre- and post-intervention time periods. The intervention involved education on obtaining respiratory cultures including technique on induced sputums and updates to CAP order sets. The primary outcome was the rate of sputum culture acquisition. Secondary outcomes included duration of anti-pseudomonal and anti-MRSA therapy, in-hospital mortality, and length of stay.ResultsA total of 143 patients met inclusion criteria, 72 in the pre-implementation group and 71 in the post-implementation group. Baseline characteristics were similar between the two groups. More patients in the post-implementation group had a sputum culture obtained but the difference was not statistically significant (38.9% vs 53.5%; p=0.08). Anti-pseudomonal therapy was continued for an average of 5.6 days pre-implementation and 5.2 days post-implementation (p=0.499). There was also not a significant difference in anti-MRSA duration between the two groups (3.4 days vs 3.2 days; p=0.606). In-hospital mortality and length of stay were similar between the two groups.ConclusionAn educational campaign focusing on the acquisition of induced sputums led to an increase in rates of sputum cultures collected. However, this did not correlate with a decrease in duration of anti-MRSA or anti-pseudomonal therapy. Further interventions should be made to optimize de-escalation of broad spectrum antibiotics based on sputum culture results.Disclosures All Authors: No reported disclosures

Bronchiectasis in Severe Asthma: Does It Make a Difference?

Background: Asthma and bronchiectasis are 2 heterogeneous diseases that frequently coexist, particularly in severe asthma. Recognition of this co-diagnosis may importantly affect treatment decisions and outcome. Previous studies in asthma with bronchiectasis show inconsistent outcomes, probably due to the heterogeneity of the included asthma cohorts. Objectives: We hypothesized that bronchiectasis contributes to asthma severity and that patients with severe asthma and bronchiectasis present with distinct characteristics resulting in different treatable traits. In addition, we explored whether bronchiectasis in severe asthma is more common in a specific phenotype. Methods: This is a single-center study consecutively including patients with severe asthma from a tertiary referral center. Severe asthma was diagnosed according to the ATS/ERS guidelines. Asthma and infectious exacerbations were defined by the attending specialist as respiratory symptoms requiring treatment with systemic steroids or antibiotics, respectively. Two independent blinded radiologists evaluated each CT. Results: 19% of patients with severe asthma showed bronchiectasis on CT. Patients with bronchiectasis had a lower FEV1% predicted (p = 0.02) and FEV1/FVC (p = 0.004) and more infectious exacerbations (p = 0.003) compared to patients without bronchiectasis. Bronchiectasis is more common in patients with a longer duration of asthma, sensitization to A. fumigatus or a positive sputum culture. Sputum cultures of patients with severe asthma and bronchiectasis revealed more P. aeruginosa, S. maltophilia, H. parainfluenzae, and A. fumigates compared to the non-bronchiectasis group. The adult-onset, eosinophilic asthma phenotype showed the highest prevalence of bronchiectasis (29.4%). Conclusions: Patients with severe asthma and coexisting bronchiectasis were found to represent a distinct group, in terms of disease severity, microbiology, and asthma phenotype. Performing (HR)CT and sputum cultures can help to identify these patients. These results can possibly contribute to early recognition and targeted treatment of this patient group.

Microbiological Etiology of Chronic Cough Associated with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD): A Study from Karachi, Pakistan

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) worsens the respiratory symptoms that are usually triggered by infection with bacteria or viruses or by environmental pollutants. Therefore, the aim of this study was to determine the bacterial etiology from sputum culture in patients suffering from acute exacerbation of COPD, admitted in hospital. Methods: The study was cross sectional observational, where sputum bacterial cultures were analyzed from the patients with Acute exacerbation COPD treated in the ICU of a tertiary care hospital for pulmonary disease from January 2019 to December 2019. Two sputum samples were collected from each patient for bacterial examination. The results of sputum bacterial culture findings were expressed as frequency and percentage by using SPSS. Results: In the present study, there were 1296 patients, both males 749 (57.8%) and females 547 (42.2%). The mean age of patients was 57.39±19.74years. 470 (36.3%) showed negative culture reports. 440 (34.0%) patients had Moraxella infection, which was most common organism in all patients, and 149 (11.5%) patients had Pseudomonas infection, 157(12.1%) patients had Yeast Albicans and in only 1 (0.1%) patient Enterobacter infection were found. Other pathogens in low frequency identified were Haemophilus parainfluenzae, Streptococcus pneumoniae, Escherichia coli and Haemophilus influenzae. It was observed that the frequency of infections was linked with increasing age. Conclusion: With increasing age, people are prone to acquire pulmonary infections specifically COPD. It is therefore very important to perform sputum culture to identify the causative agents and treat the patients with appropriate antibiotic to reduce the episodes of AECOPD. Keywords: Bacteria; Sputum Culture; COPD; Antibiotic; Cough.

Bronşektazi Tanılı Hastaların Balgam Kültür Sonuçlarının Hastanede Kalış Süresine Etkisi

Amaç: Bu çalışmanın amacı, kliniğimizde bronşektazi tanısıyla takip edilmiş hastaların balgam kültür sonuçlarının hastanede kalış süresi üzerine etkisinin olup olmadığını araştırmaktır. Materyal ve metod: Ocak 2018-aralık 2018 tarihleri arasında göğüs hastalıkları kliniğinde bronşektazi tanısyla takip edilen, 23 hastanın laboratuvar ve radyolojik verileri retrospektif olarak incelendi.Bulgular: Hastaların %39,1' de kültürde üreme olurken (9 hasta), %60,1'de kültürde üreme olmadı (14 hasta). 4 hastanın kültüründe klebsiella pnömoni, yine 4 hastanın kültüründe psödomonas aeruginosa ve 1 hastanın kültüründe de myocobacterıum tuberculosis üredi.kültür üremesi olan hastalar ile kültür üremesi olmayan hastalar hastane yatış süreleri karşılaştırıldı.Kültürde üremesi saptanan hastalarda (10.1±5.1 gün), kültürde üremesi saptanmayan hastalara (7.8±5.5 gün) göre hastane yatış süresi daha uzun olmakla beraber istatiksel olarak anlamlı bir farklılık tespit edilmedi (p=0.135). Ancak kültürde psödomonas aeruginosa üremesi olanların hastanede kalış süresi daha uzun ve istatiksel olarak ta anlamlı idi.Sonuç: Bronşektazi tanılı hastalarda kolonizasyon ve/veya enfeksiyon sık görülmektedir. Balgam kültürlerinde en sık üreyen etkenlerden biri pseudomonas aeruginosadır ve bu etken hastane yatış sürelerini arttırmaktadır. Çalışmamızda az sayıda olgu olmasına rağmen, literatür verilerine benzer sonuçlar elde edilmiştir. Ancak daha etkili değerlendirmeler yapabilmek için hasta sayısının daha yoğun olduğu benzer çalışmalara ihtiyaç vardır.

Effects of CoughAssist therapy on sputum excretion efficacy among patients with intensive care unit-acquired weakness

Objective To explore effects of CoughAssist on sputum excretion efficacy among patients with intensive care unit-acquired weakness (ICU-AW) . Methods From January 2016 to December 2017, we selected 84 ICU-AW patients with mechanical ventilation of ICU in Hu'nan Provincial People's Hospital by convenience sampling. All of the patients were divided into control group and observation group with the random number table, 42 cases in each group. Two groups all received routine treatment and nursing. On this basis, observation group carried out CoughAssist therapy. We compared the sputum excretion effects, results of sputum smear/sputum culture, arterial blood gas indexes, respiratory mechanics indexes, the incidence of ventilator-associated pneumonia (VAP) , time of mechanical ventilation, hospital days in ICU and the score of Medical Research Council (MRC) of patients between two groups. Results There were no statistical difference in the volume of sputum excretion of patients in two groups before dividing groups (P>0.05) . One to three days after treatment, the volume of sputum excretion and number of effective sputum excretion patients in observation group were more than those in control group; the positive rate of sputum culture of patients in observation group was lower than that in control group; the differences were all statistical (P 0.05) . Conclusions The application of CoughAssist in ICU-AW patients with mechanical ventilation can improve the sputum excretion effects as well as respiratory function and shorten the time of mechanical ventilation and hospital days in ICU, and improve the clinical effects. Key words: Respiration, artificial; Intensive care unit-acquired weakness; CoughAssist; Sputum excretion

Detection of Class 1 Integrons among Gram-negative Bacilli Isolated from Sputum Cultures of Patients with Lower Respiratory Tract Infections in Ahvaz, Iran

Detection of Class 1 Integrons among Gram-negative Bacilli Isolated from Sputum Cultures of Patients with Lower Respiratory Tract Infections in Ahvaz, Iran

Challenges in the identification of Ochrobactrum anthropi in blood and sputum cultures of patients with cystic fibrosis

Justificativa e objetivos: A identificação do Ochrobactrum anthropi é um desafio. Dessa forma, nós realizamos numerosos métodos de identificação em amostras de O. anthropic e associamos os resultados obtidos entre os métodos aplicados. Métodos: Os métodos seguintes são realizados: análise fenotípica manual, Vitek®2, Phoenix™, reação em cadeia da polimerase, MALDI-TOF MS™ e Biotyper Vitek™. Resultados: Os testes bioquímicos mostraram limitações para identificar O. anthropic. O Vitek®2 foi o único método que mostrou o mesmo resultado observado na análise por reação em cadeia da polimerase específica para o O. anthropic em todas as amostras, seguido por Phoenix™. MALDI-MS™ falhou na definição de espécies, e o MALDI-BD™ apresentou elevada diversidade nos resultados, sendo considerado um teste com baixa especificidade. Conclusões: Cada método mostrou vantagens e desvantagens na identificação do O. anthropic.&#x0D; Palavras-chave: MALDI-TOF; PCR; Phoenix™; Ochrobactrum anthropi; Vitek®2

Microbiological Pattern in Sputum Culture in Patients of Lung Abscess

Microbiological Pattern in Sputum Culture in Patients of Lung Abscess

Investigation of molecular epidemiology of methicillin-resistant staphylococcus aureus in department of critical care medicine

Objective: To investigate the feature of antimicrobial resistance, homology and other molecular epidemiology of methicillin-resistant staphylococcus aureus(MRSA) in Department of Critical Care Medicine(ICU). Methods: From October 2010 to December 2011, 149 strains of MRSA were collected and identified through sputum culture of patients from 10 ICUs of 10 teaching hospitals distributed in 9 chinese central city of China. Susceptibility testing to 18 kinds of antibiotic was performed, the method of pulsed field gel electrophoresis (PFGE) was used to analyze the homology, and the technique of multilocus sequencing typing (MLST) was used to identify the sequence type (ST). Results: Antibiotic susceptibility testing implied that vancomycin, daptomycin and linezolid are 100% sensitive to collected 149 strains of MRSA. Cotrimoxazole resistance rate is about 0-11.1%. Rifampicin resistant rate was less than 25% in 2 hospitals; the resistance rate of gentamicin and moxifloxacin were more than 80% besides of 50% to70% in 3 hospitals; beta lactam resistant rate was 100%. In 149 strains of MRSA, the main types of PFGE were J (28.9%), C (19.5%), G (10.7%), F (8%)types. J, C, G types mainly distributed in the North, while the F type only distributed in the Guiyang region. The MLST type: 8 ST types were determined ultimately. In which, was dominated by ST-239(67 strains, 45%), distributed in the South and North; followed by ST-5 (54 strains, 36.2%), mainly in the Northeast region (χ2=26.42, P<0.01). Conclusions: Vancomycin, daptomycin and linezolid are 100% sensitive drugs to MRSA in ICU; Higher regional homology for MRSA were observed and it is probably that homologic disseminated infection exited in ICU. It is necessary to enhance continuous monitoring and take effective nosocomial infection control action to avoid MRSA homologic outbreak.

Antimicrobial susceptibility of microorganisms isolated from sputum culture of patients with cystic fibrosis: Methicillin-resistant Staphylococcus aureus as a serious concern

IntroductionInfection is a major cause of morbidity and mortality in patients with cystic fibrosis (CF). Antimicrobial resistance of the bacterial spp. particularly methicillin resistance in Staphylococcus aureus has caused a lot of attention. The aim of this study was to describe the prevalence of S. aureus, Pseudomonas aeruginosa and Burkholderia cepacia-complex as well as their antimicrobial susceptibility patterns in CF patients in an Iranian referral pediatrics Hospital. Material and methodsFrom March 2011 until February 2012, 172 samples were collected at the Children Medical Center (CMC), an Iranian referral hospital in Tehran, Iran. Sputum specimens were cultured for the following bacterial pathogens: P. aeruginosa, S. aureus, B. cepacia complex. Antimicrobial susceptibility was performed according to the Clinical Laboratory Standards Institute recommendations. ResultsIn our study, 54% of the patients (n = 93) harbored at least once S. aureus, 30% (n = 52) P. aeruginosa, and 2% (n = 3) Burkholderia cepacia. In 40 patients (23%), none of these organisms was grown. An increasing colonization rate of P. aeruginosa in the second decade of life was found. In contrast, the colonization rate of S. aureus was constant in both decades of life. Methicillin resistant S. aureus (MRSA) was detected in 40 isolates (43%). Among MRSA, no resistance against vancomycin, linezolid and quinupristin/dalfopristin occurred. The susceptibility of P. aeruginosa isolates to meropenem, imipenem, doripenem, levofloxacin and polymixin B were more than 90%. ConclusionThe prevalence of MRSA has been rising. Since its impact on clinical outcomes, optimal prevention and treatment strategies are unclear, further studies to expand the knowledge about the infection control strategies and MRSA treatment are highly recommended.

The technical aspects of collecting and transporting the sputum cystic fibrosis patients

Timely diagnosis of infection in cystic fibrosis patients is a major aim. This is especially important for timely treatment in primary seed Ps. aeruginosa and Burkholderia cepacia. Early treatment allows in most cases to prevent the formation of chronic Pseudomonas aeruginosa infection. This also applies to re-sowing Ps. aeruginosa after the previous eradication. However, not all cities and small towns have laboratories equipped sufficiently to do bacteriological analysis of cystic fibrosis patients sputum, especially for the allocation of Ps. aeruginosa and Burkholderia cepacia. In this regard, the choice of methods of collecting material and its storage and transportation to specialized laboratories is very relevant. In 5 cities of the North-West region of Russia in 51 patients with cystic fibrosis conducted fences sputum and its subsequent delivery and carrying out of sowing in NIIDA FMBA of Russia in St Petersburg. Five patients extract sputum by coughing, 12 - induced sputum, 24 - were held flush with the posterior wall of the pharynx, 8 - swab from posterior pharyngeal wall, the parents of 2 patients brought the sputum coughed in previous day at house. As the result of bacteriologic test in 15 children certain pathogens were detected for the first time: Staphylococcus in 10 patients, Pseudomonas aeruginosa in 4 patients, Achromobacter in 1 person. Pathogens are well preserved during transportation of specimens to the laboratory in transport medium in the cold, which allows the use of bacteriological laboratories of large cities for carrying out sputum cultures of patients from other regions.

A Study on Analysis of the Sputum Gram Staining and Culture in Patients with Lower Respiratory Tract Infections Attending a Tertiary Care Hospital

Background: Microscopical examination of expectorated sputum samples is the most commonly followed method in the Microbiological laboratory for diagnosis of lower respiratory tract infections (LRTIs). Sputum sample is usually contaminated with normal resident floral organisms of the oropharynx. For the diagnosis and management of LRTIs, collection of sputum sample, sputum microscopy and culture is very important. The present study was conducted to analyse the importance of the microscopical examination of Gram stained sputum smears and the sputum culture in patients with LRTIs. Materials & Methods: The place of the study was in the department of Microbiology in a tertiary care hospital. The study period was for one year from Jan 2015 to Dec 2015. Gram staining and culture were done for all the 130 sputum samples. Gram stained sputum smears were observed under microscope for presence of organisms, pus cells and epithelial cells. Quality of expectorated sputum samples were assessed by using Bartlett’s grading system. By using standard protocols bacterial isolates were identified. Kirby Bauer disc diffusion method on Mueller Hinton agar was performed for antibiotic susceptibility testing. Results and conclusion: Out of 130 sputum samples, 72 (55.4%) samples were acceptable based on Bartlett’s screening system and 58(44.6%) samples were in the not acceptable category. Among acceptable category, 64(78.05%) samples were showed culture positivity. Among non-acceptable category, 18(21.95%) samples were showed culture positivity. Klebsiella pnemoniae-31.71% was the commonest isolated organism followed by Pseudomonas aeruginosa-14.63% and Staphylococcus aureus -13.41%.In this study authors recommended to receive good quality of sputum and do initial sputum screening for diagnosing clinically relevant LRTIs. Keywords: Bartlett’s grading system, Gram stain, Non-acceptable category, Sputum acceptable category, Sputum culture

Effect of drug resistance on negative conversion of sputum culture in patients with pulmonary tuberculosis.

Negative conversion of sputum culture is a useful marker for predicting treatment outcome and relapse of pulmonary tuberculosis (TB). The effect of drug resistance on negative conversion of sputum culture with treatment was evaluated in this study. A total of 535 patients with culture-proven pulmonary TB were classified into three groups: drug-susceptible (DS), other drug-resistant (ODR), and multidrug-resistant/extensively drug-resistant (MDR/XDR). Rates of conversion of sputum culture at 4, 8, and 12 weeks were compared. At 4 weeks of treatment, the conversion rate in the DS group (52.7%) was higher than that in the ODR group (30.8%, p=0.003), but was not different compared with the MDR group (45.7%, p=0.427). At 8 weeks, the conversion rate in the DS group (76.3%) was higher than that in the ODR (63.5%, p=0.042) and MDR groups (60.0%, p=0.031). At 12 weeks, the conversion rate in the DS group (85.9%) tended to be higher than that in the MDR group (74.3%, p=0.062), but was not different from that in the ODR group (84.6%, p=0.796). The pattern of resistance to anti-TB drugs affects culture conversion rates in the early phase of treatment and also prolongs the time to culture conversion.