Sputum Cups Research Articles

Bacterial profile, antimicrobial susceptibility patterns, and associated factors of community-acquired pneumonia among adult patients in Gondar, Northwest Ethiopia: A cross-sectional study.

IntroductionCommunity-acquired pneumonia is associated with higher morbidity, hospitalization, and mortality in adults. Likewise, antimicrobial resistance has increased in recent decades in Ethiopia. Therefore, this study was aimed to determine the bacterial isolates, their antimicrobial susceptibility patterns, and factors associated with community-acquired pneumonia among adult patients in Gondar, Northwest Ethiopia.Materials and methodsThis institutional-based cross-sectional study was conducted from April to June 2021. Sociodemographic, clinical, and other relevant data were collected using a pre-tested questionnaire. A total of 312 sputum specimens were collected using sputum cups and inoculated into blood agar, chocolate agar, mannitol salt agar, and MacConkey agar plates, which were then incubated at 37°C for 24 hours. The bacterial isolates were identified based on Gram staining, colony characteristics, and biochemical tests. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method. Inducible clindamycin resistance among the S. aureus isolates was detected by the D-test. Data were entered using EPI data version 4.6 and analyzed using SPSS version 20. P-value ≤ 0.05 at 95% CI was considered statistically significant.ResultsOf 312 cases, 39.4% (n = 123; 95% CI: 34.1%–44.9%) were found to have culture-confirmed pneumonia. The most common isolates were K. pneumoniae (31.0%, n = 39), S. pneumoniae (26.2%, n = 33), and S. aureus (20.6%, n = 26). The gram-positive bacteria were susceptible to chloramphenicol (100%) and clindamycin (96.6%). Gram-negative bacteria were susceptible to gentamicin (87.5%), azithromycin (87.1%), ciprofloxacin (86.6%), and ceftriaxone (79.0%) but highly resistant to ampicillin (100%), followed by tetracycline (87.1%), doxycycline (86.4%), co-trimoxazole (80.6%), and amoxicillin-clavulanic acid (79.0%). Overall, 72.2% of the isolates were multi-drug resistant to K. pneumoniae (94.9%, n = 37), E. coli (93.8%, n = 15), and S. pneumoniae (72.7%, n = 24). Only, 7.7% of S. aureus isolates showed inducible clindamycin resistance. Aging (AOR: 3.248, 95% CI: 1.001–10.545, p = 0.050), a history of pneumonia (AOR: 7.004, 95% CI: 3.591–13.658, p = 0.001), alcohol use (AOR: 6.614, 95% CI: 3.399–12.872, p < 0.001), and overcrowded living conditions (AOR: 4.348, 95% CI: 1.964–9.624, p = 0.001) were significantly associated with culture-positive sputum.Conclusion and recommendationsThis study found a high prevalence of bacteria-caused community-acquired pneumonia among adults and low susceptibility to ampicillin, tetracyclines, and amoxicillin-clavulanic acid. Therefore, culture-based bacterial identification and local antibiotic susceptibility testing should be performed regularly. Additionally, new insights into vaccine coverage against highly multi-drug resistant bacteria, particularly K. pneumoniae, are necessary.

Management of sputum disposal in tuberculosis ward based on PDCA circulation method

Objective To improvethe control of infection source by improving the continuous quality of disposal management. Methods PDCA method based on the management of tuberculosis disposal of the hospital quality improvement. The cross-sectional survey of tuberculosis ward in 32 cases of hospital patients, as control group.PDCA first round of sputum cup distribution and use of work for quality improvement, the reason leading the work flow of workers to nurse led work flow, the improved cross-sectional survey in 36 cases of hospital patients as experimental group 1.Aiming at the problem of low utilization rate of cup in the improvement of the first round of PDCA, the improvement of the cup was carried out,On this basis, the special disposal Cup was designed to obtain the national patent authorization. After the second round of improvement, the cross-sectional investigation in 35 patients in the hospital, as the experimental group 2. Results After two rounds of PDCA improvement, experimental group 2 groups compared with control, bedside cup configuration was not in place rate decreased from 53.1% (17/32) to 0,the difference was statistically significant (χ2=24.916, P<0.05); configuration after the cup unused rate from 53.1% (17/32) down to 8.6% (3/35), the difference was statistically significant (χ2=15.846, P<0.05). Conclusion PDCA method can improve the quality of management standard disposal. Ward cup ration is standardized disinfection ward-based nurse intervention and leading cup release, ward can improve the cup ration, improved containers (sputum cup) can improve patient compliance standard of spitting. Key words: PDCA; Tuberculosis ward; Sputum disposal; Management

Loss to follow up during diagnosis of presumptive pulmonary tuberculosis at a tertiary care hospital.

Background:Sputum microscopy is still used for diagnosis of drug-sensitive pulmonary tuberculosis (TB). Revised National Tuberculosis Control Program (TB programs) aims to rapidly diagnose and treat all cases of TB. The aim of this study is to find the proportion of loss to follow up during diagnosis of pulmonary TB after the patient reached hospital (was handed over sputum cups for sputum collection) from DOTS center after referral from respective outpatient department (OPD) at a tertiary care hospital.Methodology:Record-based data from designated microscopic center at a tertiary care hospital were collected regarding the number of patients who had been given sputum cup container for sputum collection for diagnosis of pulmonary TB referred from different OPDs from January to December 2015.Results:A total of 1518 presumptive patient for pulmonary TB had visited DOTS center after referral from different OPDs in the hospital for sputum examination during the above period. The loss to follow-up during diagnosis among presumptive pulmonary TB patient was 461 (30.04%), which was higher among those below 15 years of age. At this rate of loss to follow up of presumptive TB patient to submit sputum for diagnosis, it was estimated to be about 46 smear-positive pulmonary TB cases per year which will be missed out for diagnosis during the above period (considering sputum positivity rate is 10% in the hospital). The mean gap between sputum referral to submission of two sputum samples was 2.73 days (95% confidence interval 2.52–2.84) among those of submitted sputum for diagnosis.Conclusion:Approximately one-third of presumptive patient for pulmonary TB had loss to follow-up for diagnosis of TB even after consulting a doctor at a tertiary care hospital. There is a need to address this gap in diagnosis of pulmonary TB in this region.

Active case-finding for tuberculosis by mobile teams in Myanmar: yield and treatment outcomes

BackgroundSince 2005, the Myanmar National Tuberculosis Programme (NTP) has been implementing active case finding (ACF) activities involving mobile teams in hard-to-reach areas. This study revealed the contribution of mobile team activities to total tuberculosis (TB) case detection, characteristics of TB patients detected by mobile teams and their treatment outcomes.MethodsThis was a descriptive study using routine programme data between October 2014 and December 2014. Mobile team activities were a one-stop service and included portable digital chest radiography (CXR) and microscopy of two sputum samples. The algorithm of the case detection included screening patients by symptoms, then by CXR followed by sputum microscopy for confirmation. Diagnosed patients were started on treatment and followed until a final outcome was ascertained.ResultsA total of 9 349 people with symptoms suggestive of TB were screened by CXR, with an uptake of 96.6%. Of those who were meant to undergo sputum smear microscopy, 51.4% had sputum examinations. Finally, 504 TB patients were identified by the mobile teams and the overall contribution to total TB case detection in the respective townships was 25.3%. Among total cases examined by microscopy, 6.4% were sputum smear positive TB. Treatment success rate was high as 91.8% in study townships compared to national rate 85% (2014 cohort).ConclusionsThis study confirmed the feasibility and acceptability of ACF by mobile teams in hard-to-reach contexts, especially when equipped with portable, digital CXR machines that provided immediate results. However, the follow-up process of sputum examination created a significant barrier to confirmation of the diagnosis. In order to optimize the ACF through mobile team activity, future ACF activities were needed to be strengthened one stop service including molecular diagnostics or provision of sputum cups to all presumptive TB cases prior to CXR and testing if CXR suggestive of TB.

Improved method for collection of sputum for tuberculosis testing to ensure adequate sample volumes for molecular diagnostic testing

The quality and quantity of sputum collected has an important impact on the laboratory diagnosis of pulmonary TB. We conducted a pilot study to assess a new collection cups for the collection of sputum for the diagnosis of pulmonary tuberculosis. The pilot study utilized the standard collection cup in South Africa demonstrating a mean collection volume of 2.86±2.36SDml for 198 samples; 19% of the specimens contained <1ml and 12% contained >5ml. We designed and tested two novel sputum cups with a narrow bottom section and clear minimum and maximum markings to allow patients and clinicians to know whether sufficient sputum volume has been produced. The cups differed in their shape and manufacturing approach. The two options also support different mixing approaches being considered for a highly sensitive companion TB-screening assay being developed at Northwestern University (XtracTB assay). Sputum was collected from 102 patients at Nolungile Youth Centre, Khayelitsha, Cape Town, South Africa for a total of 204 samples. The mean volumes collected from the two cups were 2.70±0.88SDml and 2.88±0.89SDml. While the mean volumes of current and novel cups are similar, the volume ranges collected with the novel cups were narrower, and 98% of the specimen volumes were within the target range. Only 4 samples contained >5ml, but none were >6ml, and none of the specimens contained <1ml. The number of coughs that produced the samples, patient HIV and TB status plus qualitative descriptions of the sputum specimens were also evaluated.

Distribution and Availability of Essential Tuberculosis Diagnostic Items in Amhara Region, Ethiopia.

Adequate supplies of tuberculosis laboratory reagents and consumables are necessary for tuberculosis diagnosis and monitoring of treatment response. This study assessed the distribution and stock levels of laboratory commodities used in tuberculosis control in health centers of Amhara region, Ethiopia. A cross-sectional study was conducted in 82 health centers, among 801, providing sputum microscopy services. Stock levels were calculated, and distribution of reagents and consumables assessed. Thirty three (40.2%) health centers were under stocked for at least one of the key items for tuberculosis diagnosis at the time of visit. Fifteen (18.3%) health centers had no stocks of at least one of the key items (methylene blue (11%), carbol fuchsin (11%), acid alcohol (8.5%) and sputum cups (3.7%)). Of the 82 health centers, 77 (93.9%) did not fulfill the criteria for effective distribution of tuberculosis laboratory reagents and consumables. There were many health centers that had no or only low stocks of key tuberculosis laboratory reagents and consumables as a result of ineffective distribution system. It is necessary to strengthen supply chain management to ensure uninterrupted TB diagnostic service.

Breath of fresh air

conceptions that respiratory units are full of people coughing, hacking and filling sputum cups, nothing could be further from the reality. It is true that some patients need to use sputum cups, but that is only a small part of respiratory care. The respiratory unit at the Churchill Hospital in Oxford is a high-dependency unit which accepts patients directly from the hospital’s intensive care unit and from its wards. Consequently, patients present with a wide variety of conditions, many of which need constant and skilled nursing care. Non-invasive ventilation, tracheostomy care, oxygen therapy and airway humidification are some of the intensive interventions managed by specialist respiratory nurses. Respiratory diseases account for more than 30 per cent of all UK hospital admissions. Chronic obstructive pulmonary disease (COPD) and related illnesses account for around 27,000 UK deaths each year. Incidence is highest in countries where smoking has been, or still is, common.

Culturing Tuberculosis: The Multiple Meanings of Disease

The AIDS epidemic has inspired historians to reexamine tuberculosis in the nineteenth and twentieth centuries. This should not surprise us. Both diseases transformed the way Americans lived and the metaphors they lived by, and an examination of each reveals how society organizes and reorganizes itself when threatened by disease. To take one small example, the laws and rituals that evolved for disposing of used sputum cups and dirty needles contained within them complex understandings of contagion and disease and of individual and social responsibility. Similarly, chest x-rays and needle exchange programs came to symbolize the hope for prevention and the despair that far too many had already perished. Writing in the past tense about AIDS may seem odd as the epidemic continues on its relentless course. Yet, the AIDS of the 1980s is not the AIDS of the 1990s. In its short history it has been transformed from GRID (Gay-Related Immune Deficiency) to AIDS (Acquired Immune Deficiency Syndrome) to HIV (Human Immunodeficiency Virus) disease. As these shifts suggest, diseases change names, they change meanings, and they change the culture. These are the simple and compelling themes of Fevered Lives: Tuberculosis in American Culture since 1870, by Katherine Ott, a historian in the Smithsonian's Division of Science, Medicine and Society. Ott's book joins several other recent publications on the history of tuberculosis. In Bargaining for Life: A Social History of Tuberculosis, 1876-1938 (1992) Barbara Bates chronicled the life of Lawrence E Flick, a Philadelphia physician who contracted tuberculosis and dedicated his life to helping fellow sufferers. Flick founded medical institutions, sanatoriums, and voluntary organizations to fight the disease, all the while treating and corresponding with many patients. The letters he saved form the basis of Bates's finely detailed analysis of the lives of the chronically ill and their caretakers. A different perspective is offered in Sheila M. Rothman's Living in the Shadow of

Hot air sterilization at 200 degrees.

SUMMARYThe efficiency of an automatic dry heat instrument sterilizer was tested using as test inoculum a mixture of spores of Bacillus subtilis strain MD2 and B. subtilis var. niger as air dried films on stainless steel and glass objects. The sterilizer was operated at 200° and was found to be capable of sterilizing 20 stainless steel strips weighing 4 g each in an overall cycle time of c. 20 min; 6 sputum cups of total weight c. 2 kg required c. 38 min. Glass jars of equivalent weight appeared to need a longer time than did steel mugs. The factors involved in dry heat sterilization are discussed.

Nonaseptic Laboratory Rearing of the Sugarcane Borer, Diatraea saccharalis2

Environmental control was critical in laboratory rearing of the sugarcane borer, Diatraea saccharalis (F.). The effects of temperature, humidity, light, diet acidity, microorganisms, and size and type of larval rearing containers suitable for sugarcane borer culture were investigated. Temperature and humidity were standardized at 80°F and 75% RH during the first 2 instars, 80°F and 90% RH afterwards. Total darkness during the first instar encouraged earlier onset of feeding, thus limiting desiccation mortality. Diet acidity was compromised at 5.8, permitting gustatory acceptability while limiting bacterial growth. Fungi were controlled with Tegoscpt®. Glass shell vials, 80×25 mm, were most satisfactory for larval rearing and U.S. Public Health Service sputum cups of 150 cc capacity were successful as mating and egg-laying containers for adults. A detailed discussion of methods that permit rearing sugarcane borers in numbers sufficient to conduct basic studies is presented.

Vinegar eel in sputum; report of a case.

The following brief case report is presented as an illustration of an unusual finding in a routine examination of a sputum specimen. N. H., a white male manufacturing executive, 50 years of age, was admitted to the hospital March 28, 1950, for investigation of an acute episode of rather profuse hemoptysis. The clinical history revealed that he had had a chronic productive cough since childhood and pulmonary hemorrhage had occurred on two previous occasions. The bronchogram confirmed the clinical diagnosis of extensive saccular bronchiectasis involving chiefly the left lower lobe and the lingula. The rest of the lung fields were roentgenographically normal in appearance. Routine sputum examinations disclosed the presence on one occasion of an organism resembling the larva of Filaria, Strongyloides or hookworm. Inasmuch as a fresh disposable sputum cup was used for each specimen, the organism was not thought to be a contaminant. The question at once arose

PRIMARY INOCULATION TUBERCULOSIS OF THE SKIN

Little has appeared in the pediatric literature on the subject of traumatic inoculation tuberculosis of the skin with metastasis to the regional lymph nodes. Holt and McIntosh1stated that the disorder is comparatively rare and that the primary lesion, in particular, is likely to pass unrecognized because tuberculosis is not considered. A better acquaintance with the clinical manifestations of this lesion would probably result in its being identified more frequently by pediatricians and surgeons. Tscherning2in 1888 reported the case of a servant who wounded a finger with a fragment of sputum cup while attending a tuberculous patient. Tuberculous lymphatic involvement followed, and it was necessary to amputate the finger and to remove the affected glands before recovery ensued. In 1909 Escherich3reported the case of a child with inoculation tuberculosis of the cheek. Klebs4mentioned in his book the occurrence of extensive tuberculosis of the

New Inventions.: A NEW SPUTUM CUP AND HOLDER

New Inventions.: A NEW SPUTUM CUP AND HOLDER

STUDIES OF THE PNEUMOCOCCUS AND ALLIED ORGANISMS WITH REFERENCE TO THEIR OCCURRENCE IN THE HUMAN MOUTH

1. In the course of experiments for obtaining pneumococci from the oral secretions of human individuals, the "plate method" described in this paper was found to be the most reliable method for isolating pneumococci. 2. An alkaline two-per-cent, glucose-serum-agar was regarded as the most favorable medium for the rapid development of colonies of the pneumococcus. 3. The morphological identification of the pneumococcus was made by means of a special capsule-stain. The recognition of the organism was accomplished with precision and reliability when present in the blood and exudate of test animals, and upon the various culture media employed. 4. Pure cultures of pneumococci could by the methods described be obtained within forty-eight hours for inoculation into animals for tests of virulence. 5. Normal persons often harbor the pneumococcus in their mouths. Of the seventy-eight cases examined, thirty-nine showed the presence of the pneumococcus. 6. In a second and larger series of studies on so-called normal cases by means of cultures made from the throat on Loeffler's medium, the organism was detected seventy-one times in 204 examinations, or in 348%. In 145 cases the Streptococcus mucosus capsulatus occurred eight times (5.5%), and the Friedländer bacillus twenty-one times (14.5%). 7. Certain individuals may acquire the pneumococcus in their mouths in the hospital wards, and may continue to harbor it for a considerable period of time. 8. The pneumococcus may persist for days or weeks in the mouths of patients who have recovered from pneumonia. 9. From a study of patients in the hospital wards, certain conclusionsin regard to communicability were drawn. "Normal" individuals, in whose mouths the pneumococcus is repeatedly found to be absent, may acquire the organism by association with pneumonia or "positive normal" cases. The handker-chiefsand dishes of pneumonia and "positive normal" cases are to be regarded as some of the means of transference of the organismfrom person to person. The lips of drinking-cups and the sputum or saliva in sputum cups were found to contain living and virulent pneumococci. 10. Certain characteristic morphological types of the pneumococcuswere regularly met with in this study. These include the following: (1) the typical, (2) the small, (3) the large, (4) the bacillary, and (5) the streptococcus type of the pneumococcus. 11. Pneumococci in the mouths of normal individuals possess the morphological and cultural properties which are characteristic of the same organisms when isolated from other sources. 12. All pneumococci possess the power of fermenting inulin with the formation of acid, even if not in all generations. But this holds true only when the inulin serum-water medium as modified by the writer is used. 13. A certain configuration of the colonies, designated by the term "ring-form," when present is diagnostic of the pneumococcus. 14. The percentage of virulent pneumococci present in the mouths of normal persons was 79; in cases of pneumonia, 77. 15. Pneumococci of the large mucoid type, and giving large mucoid colonies, should be distinguished from the Streptococcus mucosus capsulatus. 16. There are doubtful diplococci of atypical morphology which can be grouped neither with the pneumococci nor with the streptococci, although they possess many features in common with both. 17. The Streptococcus mucosus capsulatus belongs to a group which is related to, but distinct from, the pneumococcus. 18. Morphological characters and animal tests are of greatest value in the identification of the pneumococcus. By the employment of suitable culture media it is possible, in most instances,to recognize the pneumococcus by its morphology alone. The chief cultural tests are the following: the manner of growth upon the serum-glucose-agar, and the modified inulin-serum water, and the appearance of the "ring-type" of colony. 19. All pneumococci, irrespective of their source, were agglutinatedby means of pneumococcus immune serum. 20. An immune pneumococcus serum was found capable of agglutinating various pyogenic streptococci, certain atypical organisms, and several strains of the Streptococcus mucosus capsulatus. 21. The serum of pneumonia patients varied in its power to agglutinate different pneumococci. Some strains were agglutinated, others not. 22. The sera of normal individuals and of normal rabbits possess no agglutinating power for pneumococci, the atypical organisms, certain streptococci, and the Streptococcus mucosus capsulatus.