Guided sputum sample collection and culture contamination rates in the diagnosis of pulmonary TB

Maciel, Ethel Leonor Nóia; Prado, Thiago Nascimento do; Peres, Renata Lyrio; Palaci, Moisés; Johnson, John L.; Dietze, Reynaldo

doi:10.1590/s1806-37132009000500012

Cited by 14 publications

(14 citation statements)

References 4 publications

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“…We observed less contamination with spot samples (which were supervised at collection sites) when compared with the EM samples (which were not unsupervised at collection sites); however, this may not be significant since we did not provide patients with water or other materials to minimize normal flora prior to expectoration. Nevertheless, this finding is supported by similar findings in a previous study [27]. It is also worth noting that high contamination rates may have contributed to underestimation of TB cases by MGIT and increased the cost of doing the test.…”

Section: Discussionsupporting

confidence: 89%

An Early Morning Sputum Sample Is Necessary for the Diagnosis of Pulmonary Tuberculosis, Even with More Sensitive Techniques: A Prospective Cohort Study among Adolescent TB-Suspects in Uganda

Ssengooba

Kateete

Wajja

et al. 2012

Tuberculosis Research and Treatment

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The World Health Organization (WHO) recommends collection of two sputum samples for tuberculosis (TB) diagnosis, with at least one being an early morning (EM) using smear microscopy. It remains unclear whether this is necessary even when sputum culture is employed. Here, we determined the diagnostic yield from spot and the incremental yield from the EM sputum sample cultures among TB-suspected adolescents from rural Uganda. Sputum samples (both spot and early-morning) from 1862 adolescents were cultured by the Lowenstein-Jensen (LJ) and Mycobacterium Growth Indicator Tube (MGIT) methods. For spot samples, the diagnostic yields for TB were 19.0% and 57.1% with LJ and MGIT, respectively, whereas the incremental yields (not totals) of the early-morning sample were 9.5% and 42.9% (P < 0.001) with LJ and MGIT, respectively. Among TB-suspected adolescents in rural Uganda, the EM sputum culture has a high incremental diagnostic yield. Therefore, EM sputum in addition to spot sample culture is necessary for improved TB case detection.

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Section: Discussionsupporting

confidence: 89%

An Early Morning Sputum Sample Is Necessary for the Diagnosis of Pulmonary Tuberculosis, Even with More Sensitive Techniques: A Prospective Cohort Study among Adolescent TB-Suspects in Uganda

Ssengooba

Kateete

Wajja

et al. 2012

Tuberculosis Research and Treatment

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“…Fourteen of the 40 patients confirmed to have TB had positive cultures only on specimens collected after rinsing with an antiseptic mouthwash. Our results add to the growing body of knowledge showing that attention to sputum collection methods and oral hygiene may enhance the yield of sputum examination (1,6,8,10).…”

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confidence: 63%

Evaluation of Oral Antiseptic Rinsing before Sputum Collection To Reduce Contamination of Mycobacterial Cultures

et al. 2011

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To assess whether rinsing with oral antiseptics before sputum collection would reduce contamination of mycobacterial cultures, 120 patients with suspected tuberculosis were randomly assigned to rinse with chlorhexidine or cetylpyridinium mouthwash before collection. The culture contamination rate was significantly lower after rinsing with chlorhexidine before collection, especially for cultures grown in MGIT medium.One of the main limitations of sputum culture for mycobacteria is contamination and overgrowth with organisms from the oral flora. Antiseptics have been used to supplement oral hygiene to minimize the proliferation of pathogenic organisms (13). Due to their glycolipid-containing cell wall, mycobacteria are relatively resistant to many common disinfectants (14,15). Chlorhexidine (CHX) and cetylpyridinium chloride (CPC), two of the most widely used antiseptic compounds in mouthwashes, are active against common oral bacteria and fungi at low concentrations (2,3,4,9,11,16) and are relatively nontoxic to human cells. Mycobacteria are highly resistant to CHX (16). CPC has been used at a 0.5% final concentration in the decontamination of sputum for mycobacterial culture (17).Better methods are needed to decrease the contamination rate of sputum specimens for mycobacterial culture. We conducted a randomized trial to assess whether oral rinsing with mouthwashes containing CHX and CPC before sputum collection would decrease the rate of culture contamination. The protocol was approved by the institutional review board. All patients gave informed consent for participation. Eighteen-to 60-year-old adults with suspected pulmonary tuberculosis (TB) evaluated at two public clinics from December 2007 to December 2008 were eligible. One sputum sample was collected from each patient on two consecutive days. On the first day, a first morning sputum sample was collected at the clinic using routine procedures (control group) in which patients washed their hands with soap and water and rinsed their mouths with tap water before collecting the specimens. Patients returned to the clinic the next morning, when they were randomly assigned using a computer-generated sequence to rinse their mouths with 10 ml of a commercially available mouthwash solution for 1 min before sample collection. The solutions used were (i) Periogard solution (Colgate-Palmolive, São Paulo, Brazil), containing a 0.12% final concentration of CHX gluconate, and (ii) Colgate Plus solution (Colgate-Palmolive, São Paulo, Brazil), containing a final concentration of 0.05% of CPC. Specimens were refrigerated at 4°C until processing within 2 h after collection. Decontamination of specimens was done as previously described (12). The sediment was resuspended in phosphate-buffered saline (PBS) and inoculated on Ogawa slants

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“…A total of 70 Sputum samples were collected from patient attending Tanta Chest Disease Hospital during April 2016 to March 2017. According to Maciel et al (2009), Samples were collected early morning after fasting for 8-10hr on a period of two consecutive days. Collection of samples was carried out under direct supervision and using standardized guidance as follows; each patient was asked to use a toothbrush (provided by the study), without toothpaste, to gently remove any food residue from teeth and gums.…”

Section: Collection Of Specimensmentioning

confidence: 99%

Prevalence of Some Virulence Factors among Gram Negative Bacteria Isolated from Patients with Lung Infection and Their Antimicrobial Susceptibility Patterns

et al. 2019

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B ACTERIAL lung infections can be serious and life-threatening diseases in people of all ages. Recently, bacterial resistance to antibiotics has increased rapidly and the most serious concern is that some bacteria have become resistant to almost all of the easily available antibiotics. The present work aimed to study the relation between some of the expressed virulence factors and antibiotic resistance among local Gram negative bacteria isolated from infected lungs of patients attended Tanta University hospital, Egypt. Out of 70 different clinical specimens, 30 Gram negative isolates were obtained; 46.6% and 53.3% of total isolates were Pseudomonas aeruginosa and Enterobacteriaceae, respectively. All bacterial isolates were tested for their susceptibility against 24 antimicrobial agents as well as the ability to express some virulence factors including hemolysin, gelatinase, protease, lipase, pigment and biofilm formation. The results showed the predominance of P. aeruginosa isolates resistance against many of the used antibiotics, with significantly higher mean percent of drug resistant (74.11±7.7) compared to that of Enterobacteriaceae (42.97±9.09). Also, all Pseudomonas isolates were extensively drug resistant (XDR), while Enterobacteriaceae were multi-drug resistance (MDR). Although, most virulence factors were expressed at higher rates in P. aeruginosa than other bacterial species, no relation between the studied virulence factors and antibiotic resistance except for biofilm production, as the results indicated a direct correlation between resistance of antibiotics and the production of biofilm from tested Gram negative bacteria. There was a significant association between biofilm formation and the extensivedrug resistant of Pseudomonas isolates compared to Enterobacteriaceae (P= 0.02).

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Guided sputum sample collection and culture contamination rates in the diagnosis of pulmonary TB

Cited by 14 publications

References 4 publications

An Early Morning Sputum Sample Is Necessary for the Diagnosis of Pulmonary Tuberculosis, Even with More Sensitive Techniques: A Prospective Cohort Study among Adolescent TB-Suspects in Uganda

An Early Morning Sputum Sample Is Necessary for the Diagnosis of Pulmonary Tuberculosis, Even with More Sensitive Techniques: A Prospective Cohort Study among Adolescent TB-Suspects in Uganda

Evaluation of Oral Antiseptic Rinsing before Sputum Collection To Reduce Contamination of Mycobacterial Cultures

Prevalence of Some Virulence Factors among Gram Negative Bacteria Isolated from Patients with Lung Infection and Their Antimicrobial Susceptibility Patterns

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