Usefulness of sputum gram stain for etiologic diagnosis in community-acquired pneumonia: a systematic review and meta-analysis

Rio‐Pertuz, Gaspar Del; Gutiérrez, Josefina; Triana, Abel; Molinares, Jorge L.; Robledo‐Solano, Andrea; Meza, Jose L.; Ariza‐Bolívar, Orlando; Acosta‐Reyes, Jorge; Garavito, Argenis; Viasus, Diego; Carratalà, Jordi

doi:10.1186/s12879-019-4048-6

Cited by 41 publications

(37 citation statements)

References 45 publications

(29 reference statements)

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“…A recent meta-analysis considering the diagnostic threshold of >50 per cent for predominant morphotype reported a pooled sensitivity of 64 per cent for GNB, 72 per cent for S. aureus and 78 per cent for H. influenzae . The positive likelihood ratio was highest for GNB (37.49), followed by H. influenzae (21.08), S. aureus (16.27) and least for S. pneumoniae (4.60) 54 . Besides poor to moderate sensitivity, Grams stain is affected by lack of quality control tool and high interobserver variations when observed by different technologists 55 .…”

Section: Microbiological Diagnostics In Cabp-bridging Ideal and Real mentioning

confidence: 99%

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Community-acquired bacterial pneumonia in adults: An update

2020

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Community-acquired pneumonia (CAP) is the prominent cause of mortality and morbidity with important clinical impact across the globe. India accounts for 23 per cent of global pneumonia burden with case fatality rates between 14 and 30 per cent, and Streptococcus pneumoniae is considered a major bacterial aetiology. Emerging pathogens like Burkholderia pseudomallei is increasingly recognized as an important cause of CAP in Southeast Asian countries. Initial management in the primary care depends on clinical assessment while the hospitalized patients require combinations of clinical scores, chest radiography and various microbiological and biomarker assays. This comprehensive diagnostic approach together with additional sampling and molecular tests in selected high-risk patients should be practiced. Inappropriate therapy in CAP in hospitalized patients lengthens hospital stay and increases cost and mortality. In addition, emergence of multidrug-resistant organisms poses tough challenges in deciding empirical as well as definitive therapy. Developing local evidence on the cause and management should be a priority to improve health outcomes in CAP.

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Section: Microbiological Diagnostics In Cabp-bridging Ideal and Real mentioning

confidence: 99%

“…ICU, intensive care unit; PCR, polymerase chain reaction. Source : Refs 29 38 54 58 59 82 85 86 88 .…”

Section: Microbiological Diagnostics In Cabp-bridging Ideal and Real mentioning

confidence: 99%

Community-acquired bacterial pneumonia in adults: An update

2020

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“…Gram stain examination is a simple and rapid diagnostic tool for the presumptive identification of causative bacteria in patients with CAP. Its diagnostic usefulness in the selection of appropriate antibiotics in clinical practice has been investigated in several previous studies [ 26 , 27 ]. In the current study, the sensitivity of sputum Gram stain for MC-CAP diagnosis was lower than that for SP-CAP; however, the rate was relatively high.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of community-acquired pneumonia due to Moraxella catarrhalis in adults: a retrospective single-centre study

et al. 2020

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Background Although Moraxella catarrhalis (M. catarrhalis) is a common cause of community-acquired pneumonia (CAP), studies investigating clinical manifestations of CAP due to M. catarrhalis (MC-CAP) in adults are limited. Since S. pneumoniae is the leading cause of CAP globally, it is important to distinguish between MC-CAP and CAP due to S. pneumoniae (SP-CAP) in clinical practice. However, no past study compared clinical characteristics of MC-CAP and SP-CAP by statistical analysis. We aimed to clarify the clinical characteristics of MC-CAP by comparing those of SP-CAP, as well as the utility of sputum Gram staining. Methods This retrospective study screened CAP patients aged over 20 years visiting or admitted to Okinawa Miyako Hospital between May 2013 and April 2018. Among these, we included patients whom either M. catarrhalis alone or S. pneumoniae alone was isolated from their sputum by bacterial cultures. Results We identified 134 MC-CAP and 130 SP-CAP patients. Although seasonality was not observed in SP-CAP, almost half of MC-CAP patients were admitted in the winter. Compared to those with SP-CAP, MC-CAP patients were older (p < 0.01) and more likely to have underlying pulmonary diseases such as asthma and bronchiectasis (p < 0.01). Approximately half of asthmatic MC-CAP and SP-CAP patients had asthma attacks. Although winter is an influenza season in Japan, co-infection with influenza virus was less common in MC-CAP compared to SP-CAP patients (3% vs. 15%, p < 0.01). Bronchopneumonia patterns on X-ray, as well as bronchial wall thickening, bilateral distribution, and segmental pattern on CT were more common in MC-CAP patients than in SP-CAP patients (p < 0.01). Sputum Gram stain was highly useful method for the diagnosis in both MC-CAP and SP-CAP (78.4% vs. 89.2%), and penicillins were most frequently chosen as an initial treatment for both pneumonias. Conclusions This is the first study to show that MC-CAP occurred in older people compared to SP-CAP, influenza virus co-infection was less common in MC-CAP than SP-CAP, and that MC-CAP frequently caused asthma attacks. Gram stain contributed for the appropriate treatment, resulting in conserving broad-spectrum antibiotics such as cephalosporins and fluoroquinolones in both MC-CAP and SP-CAP patients.

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“…It also prevents futile consumption of resources and time in processing inappropriate contaminated samples that are of no benefit to the management of the patients. 1 Increasing the use of microscopy prior to culture may increase the specificity of the sputum culture in diagnosis of respiratory infections.…”

Section: Introductionmentioning

confidence: 99%

A bacterial and fungal profile of sputum samples in a tertiary care hospital in Puducherry

G¹,

Prabha²,

Pramodhini³

et al. 2021

IJMR

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The microscopic examination of gram stained sputum sample aids in diagnosis of patients with lower respiratory tract infections. Gram stain plays the key role in deciding the appropriateness of the quality of the sputum sample received in the laboratory for culture. It helps to determine the represent ativeness of the sample for the site of collection intended. Aim: This study was done to correlate gram stain findings with culture and to assess the use of Gram stain in sputum examination in diagnostic microbiology. Materials and Methods: During 2017 (July to December) a total of 133 sputum samples were quality assessed using Bartlett's grading system. The total scoring was done and sample showing score of 1 and above were cultured and identified based on colony characteristics, gram staining morphology and biochemical reactions. Results: One hundred and thirty-three sputum samples were collected from patients with suspected lower respiratory tract infection. Of the 133 samples, 110(79%) were accepted and 23 (21%) were found to be unacceptable by Bartlett criteria. Potential pathogens were grown in 84 samples in the acceptable category. Normal respiratory flora were grown in 26 samples. Out of 84 samples, 63 samples were positive for bacterial growth and 21 showed fungal growth. Out of 63 bacterial growth, 44 were from in-patients and 19 were from out-patients. Among these bacterial isolates, 23 isolates were Pseudomonas aeruginosa followed by 16 isolates were Klebsiella pneumoniae, 10 isolates were E.coli, 6 isolates were Staphylococcus aureus, 2 isolates were Streptococcus species, 3 isolates were Proteus mirabilis and 3 isolates were Serratia marcesens. Conclusions: All the sputum samples should be subjected to gram staining before culture to differentiate true pathogens from contaminating flora on culture.

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Usefulness of sputum gram stain for etiologic diagnosis in community-acquired pneumonia: a systematic review and meta-analysis

Cited by 41 publications

References 45 publications

Community-acquired bacterial pneumonia in adults: An update

Community-acquired bacterial pneumonia in adults: An update

Clinical characteristics of community-acquired pneumonia due to Moraxella catarrhalis in adults: a retrospective single-centre study

A bacterial and fungal profile of sputum samples in a tertiary care hospital in Puducherry

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