Source: Annual Congress 2001 - Community-acquired pneumonia: from diagnosis to discharge
Disease area: Respiratory infections

Abstract

OBJECTIVES. We evaluated the role of sputum in the management of patients with CAP in a primary care hospital without microbiological laboratory facilities.
DESIGN AND INTERVENTIONS. Regular collection of sputum samples, Gram staining in a local laboratory, and mailing of samples for culture in a commercial laboratory were implemented as a diagnostic strategy.
PATIENTS. 116 consecutive patients with CAP were prospectively recorded during a 12 month period.
RESULTS. 42/116 (36%) patients were capable of producing a sputum sample. Age > 75 years (OR 0.4, 95% CI 0.18 - 0.93) and prior ambulutory antimicrobial treatment (OR 3.2, 95% CI 1.2 - 8.4) were independent predictors of sputum production. A delay in collection and processing of sputum samples was present in 31% and 39%, respectively. The former yielded an increased number of GNEB and nonfermenters (44% vs 7%, p = 0.056). The latter was associated with an increase of Candida spp. isolates (80% versus 6%, p = 0.003). The overall diagnostic yield was low (10 of 116, 8%) due to a limited number of valid samples (n = 23 of 42, 55%) and of definitely or probably positive samples in Gram stain and culture (n = 10 of 42, 24%). Prior ambulatory antimicrobial treatment was associated with a reduction in diagnostic yield (14% vs 56%, p = 0.09). The impact of diagnostic results on antimicrobial treatment decisions was minimal, with directed antimicrobial treatment according to diagnostic results in only one patient.
CONCLUSIONS. We conclude that in this setting representative for primary care hospitals in Germany, sputum failed to be useful and should not form part of an initial management approach for the selection of initial antimicrobial treatment.

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S. Ewig, M. Schlochtermeier, N. Göke, M. S. Niederman (Bonn, Wesseling, Germany; Mineola, United States Of America). Applying sputum as a diagnostic tool in pneumonia - limited yield, minimal impact on treatment decisions. Eur Respir J 2001; 16: Suppl. 31, 3390

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