title: Applying sputum as a diagnostic tool in pneumonia: limited yield, minimal impact on treatment decisions.
abstract: OBJECTIVE
  We evaluated the role of sputum examination in the management of patients with community-acquired pneumonia (CAP) in a primary-care hospital without microbiologic laboratory facilities.
  
  
  METHODS
  A diagnostic strategy using regular collection of sputum samples, Gram staining in a local laboratory, and mailing of samples to a commercial laboratory for culture analysis.
  
  
  METHODS
  A 200-bed primary-care hospital without subspeciality physicians.
  
  
  METHODS
  One hundred sixteen consecutive patients with a diagnosis of CAP were prospectively evaluated during a 12-month period.
  
  
  RESULTS
  Of 116 patients, 42 patients (36%) were capable of producing a sputum sample. Age > or = 75 years (odds ratio [OR], 0.4; 95% confidence interval [CI], 0.18 to 0.93) and prior ambulatory antimicrobial treatment (OR, 3.2; 95% CI, 1.2 to 8.4) were independent predictors of sputum production. A delay in collection and processing of sputum samples of > 24 h was present in 31% and 39%, respectively. A delay in collection yielded an increased number of Gram-negative enteric bacilli and nonfermenters (44% vs. 7%, p = 0.056). A delay in processing was associated with an increased number of Candida spp isolates (33% vs. 9%, p = 0.16). The overall diagnostic yield was low (10 of 116 patients, 9%) due to a limited number of valid samples (n = 23 of 42 patients, 55%) and a limited number of definitely or probably positive samples on Gram's stain and culture (n = 10 of 42 patients, 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 antimicrobial treatment directed to diagnostic results in only one patient.
  
  
  CONCLUSIONS
  We conclude that in this setting representative of primary-care hospitals in Germany, sputum had a low diagnostic yield and did not contribute significantly to patient management.
authors: Medizinische Universitätsklinik und Poliklinik Bonn, Bonn, Germany. santiago.ewig@ukb.uni-bonn.de
authors: Santiago
authors: S
authors: Ewig
authors: Matthias
authors: M
authors: Schlochtermeier
authors: Norbert
authors: N
authors: Göke
authors: Michael S
authors: MS
authors: Niederman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D013048:Specimen Handling; D013183:Sputum / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents