Sputum specimens can be obtained from patients with community-acquired pneumonia in primary care

Lagerström, Folke; Fredlund, Hans; Holmberg, Hans

doi:10.1080/02813430410006468

Cited by 8 publications

(6 citation statements)

References 27 publications

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“…The prevalence of CKD, particularly stage 3 CKD, was found to be significantly higher in subjects aged 60 years and older. However, it is very likely that most of the elderly participants had age-related renal impairments rather than CKD [47], making it necessary to evaluate age-related renal functional changes during evaluation of high-prevalence CKD among subjects aged over 60 years. In addition, the MDRD equation has not been validated for the Turkish population, and its accuracy in predicting actual GFR in Turkish men and women is not known.…”

Section: Discussionmentioning

confidence: 99%

A population-based survey of Chronic REnal Disease In Turkey--the CREDIT study

Süleymanlar

Utaş

Arınsoy

et al. 2010

Nephrology Dialysis Transplantation

193

132

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Background. Chronic kidney disease (CKD) is a growing health problem worldwide that leads to end-stage kidney failure and cardiovascular complications. We aimed to determine the prevalence of CKD in Turkey, and to evaluate relationships between CKD and cardiovascular risk factors in a population-based survey.Methods. Medical data were collected through home visits and interviews. Serum creatinine, blood glucose, total cholesterol, triglycerides, HDL, LDL and uric acid were determined from 12-h fasting blood samples, and spot urine tests were performed for subjects who gave consent to laboratory evaluation.Results. A total of 10 872 participants were included in the study. The final analysis was performed on 10 748 subjects (mean age 40.5 ± 16.3 years; 55.7% women) and excluded 124 pregnant women. A low glomerular filtration rate (GFR) (< 60 mL/min/1.73 m2) was present in 5.2% of the subjects who were evaluated for GFR, while microalbuminuria and macroalbuminuria were observed in 10.2% and 2% of the subjects, respectively. The presence of CKD was assessed in subjects who gave consent for urinary albumin excretion measurement (n = 8765). The overall prevalence of CKD was 15.7%; it was higher in women than men (18.4% vs. 12.8%, P < 0.001) and increased with increasing age of the subjects. The prevalence of hypertension (32.7% in the general population), diabetes (12.7%), dyslipidaemia (76.3%), obesity (20.1%) and metabolic syndrome (31.3%) was significantly higher in subjects with CKD than subjects without CKD (P < 0.001 for all).Conclusions. The prevalence of CKD in Turkey is 15.7%. Cardiovascular risk factors were significantly more prevalent in CKD patients.

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Section: Discussionmentioning

confidence: 99%

A population-based survey of Chronic REnal Disease In Turkey--the CREDIT study

Süleymanlar

Utaş

Arınsoy

et al. 2010

Nephrology Dialysis Transplantation

193

132

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“…The first criterion for HQ sputum sample was ≤ 2.5 SECs per field at a 400× magnification (or ≤ 10 SECs per 100× field) and a leukocytes/epithelial cells ratio > 5 (HQ1) [ 8 , 12 ]. We also applied another less stringent criterion for HQ sputum sample (HQ2), according to which the sputum quality was rated high if the ratio of leukocytes/epithelial cells was > 1 [ 10 , 11 , 16 ]. The sputa not fulfilling the HQ1 and HQ2 criteria were considered to be of low-quality (LQ1 and LQ2, respectively).…”

Section: Methodsmentioning

confidence: 99%

“…A commonly used definition for adequate quality of sputum is > 25 PMNs and < 10 SECs per low power field [ 3 – 5 ]. However, there are variations in the criteria used and other PMNs or leukocytes to SECs ratios such as ≥ 20 [ 6 ], ≥ 10 [ 7 ], > 5 [ 8 ], ≥ 2 [ 9 ], and > 1 [ 10 , 11 ] have also been applied. In a simple screen, only SECs are assessed and samples with less than a certain number of SECs per field such as 10 SECs [ 2 , 12 , 13 ] or 25 SECs [ 3 ] are considered as adequate.…”

Section: Introductionmentioning

confidence: 99%

Culture of all sputum samples irrespective of quality adds value to the diagnosis of pneumococcal community-acquired pneumonia in the elderly

Saukkoriipi

Palmu

Jokinen

2019

Eur J Clin Microbiol Infect Dis

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Culture of expectorated sputum in the microbiological diagnosis of community-acquired pneumonia (CAP) is considered valid only if high-quality (HQ) samples are obtained, but evidence regarding pneumococcal etiology specifically is lacking. We studied 323 radiologically confirmed CAP cases in patients aged ≥ 65 years. Sputum samples were assessed for quality microscopically and cultured. Two quality criteria sets were applied to delineate HQ from low-quality (LQ) sputa: leukocytes/epithelial cells ratio > 5 and ≤ 2.5 epithelial cells/400× magnification field (HQ1), or leukocytes/epithelial cells ratio > 1 (HQ2). A sputum sample was obtained and the quality assessed in 224 cases; 47% were HQ1 and 76% HQ2. Encapsulated pneumococci (EPnc) were cultured in 25 (24%), 14 (12%), 35 (21%), and 4 (7%) of the HQ1-, LQ1-, HQ2-, and LQ2-samples, respectively. If another pneumococcal test (blood culture, urine antigen, or ≥ twofold increase in CbpA or PsaA antibodies) was positive, EPnc were cultured at similar proportions in HQ1- and LQ1-sputa; if the other test was negative, EPnc were cultured less often in LQ1- than HQ1-sputa. EPnc were found less often in LQ2- than in HQ2-sputa. Our results suggest similar specificity in LQ- and HQ-sputum cultures. All sputum samples add value to the pneumococcal CAP-diagnosis in the elderly. Electronic supplementary material The online version of this article (10.1007/s10096-019-03536-9) contains supplementary material, which is available to authorized users.

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“…[ 72 ] Accurate estimate of GFR is important to detect elderly patients at risk for progressive CKD, but also in order to guide drug therapy of potentially nephrotoxic drugs, or to adapt therapy with renally excreted drugs which is often desirable in elderly patients on polypharmacy. [ 73 , 74 , 75 ]…”

Section: Methodsmentioning

confidence: 99%

Individualizing Pharmacotherapy in Patients with Renal Impairment: The Validity of the Modification of Diet in Renal Disease Formula in Specific Patient Populations with a Glomerular Filtration Rate below 60 Ml/Min. A Systematic Review

Eppenga¹,

Kramers

Derijks

et al. 2015

PLoS ONE

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BackgroundThe Modification of Diet in Renal Disease (MDRD) formula is widely used in clinical practice to assess the correct drug dose. This formula is based on serum creatinine levels which might be influenced by chronic diseases itself or the effects of the chronic diseases. We conducted a systematic review to determine the validity of the MDRD formula in specific patient populations with renal impairment: elderly, hospitalized and obese patients, patients with cardiovascular disease, cancer, chronic respiratory diseases, diabetes mellitus, liver cirrhosis and human immunodeficiency virus.Methods and FindingsWe searched for articles in Pubmed published from January 1999 through January 2014. Selection criteria were (1) patients with a glomerular filtration rate (GFR) < 60 ml/min (/1.73m2), (2) MDRD formula compared with a gold standard and (3) statistical analysis focused on bias, precision and/or accuracy. Data extraction was done by the first author and checked by a second author. A bias of 20% or less, a precision of 30% or less and an accuracy expressed as P30% of 80% or higher were indicators of the validity of the MDRD formula. In total we included 27 studies. The number of patients included ranged from 8 to 1831. The gold standard and measurement method used varied across the studies. For none of the specific patient populations the studies provided sufficient evidence of validity of the MDRD formula regarding the three parameters. For patients with diabetes mellitus and liver cirrhosis, hospitalized patients and elderly with moderate to severe renal impairment we concluded that the MDRD formula is not valid. Limitations of the review are the lack of considering the method of measuring serum creatinine levels and the type of gold standard used.ConclusionIn several specific patient populations with renal impairment the use of the MDRD formula is not valid or has uncertain validity.

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Sputum specimens can be obtained from patients with community-acquired pneumonia in primary care

Abstract: Clinically important renal impairment is common in old age, especially in the frailest elderly living in nursing homes. This finding underlines the necessity for close supervision of drug treatment based on renal function in old age.

Cited by 8 publications

References 27 publications

A population-based survey of Chronic REnal Disease In Turkey--the CREDIT study

A population-based survey of Chronic REnal Disease In Turkey--the CREDIT study

Culture of all sputum samples irrespective of quality adds value to the diagnosis of pneumococcal community-acquired pneumonia in the elderly

Individualizing Pharmacotherapy in Patients with Renal Impairment: The Validity of the Modification of Diet in Renal Disease Formula in Specific Patient Populations with a Glomerular Filtration Rate below 60 Ml/Min. A Systematic Review

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