title: Indicators of bacterial infection in patients with acute exacerbation of chronic bronchitis for application in clinical trials of antibacterial drugs.
abstract: OBJECTIVE
  This study examined the accuracy of: (a) patient symptoms; (b) microscopic examination of sputum purulence (>25 WBCs and <10 epithelial cells) and (c) microscopic examination of morphological bacterial cell types, in identifying bacterial infection in patients with an acute exacerbation of chronic bronchitis (AECB) for entry to clinical trials.
  
  
  METHODS
  Subjects had a worsening of at least two symptoms from: dyspnoea, sputum volume, and sputum purulence (Anthonisen Type 1 or 2 exacerbation). Sputum samples were collected from all subjects.
  
  
  RESULTS
  A total of 97 sputum samples were evaluated. Overall, 58 (60%) subjects were culture-positive; 22 of 29 (76%) subjects with Type 2 exacerbation had a bacterial pathogen isolated compared with 36 of 68 (53%) Type 1 subjects. This difference was not statistically significant. Microscopically purulent samples were found to be significantly more likely to be culture-positive than non-purulent samples. However, the sensitivity (60%) and specificity (67%); and the positive predictive value (73%) and negative predictive value (53%) observed, means that this is not an ideal predictive test for clinical trials. A semi-quantitative approach to Gram staining was identified as a potential indicator of bacterial infection. Sputum specimens with one bacterial cell type present at >10 cells per field, or more than one cell type present with at least one type at a concentration of >25 cells per field, had a high proportion (91%) of culture-positive specimens.
  
  
  CONCLUSIONS
  Symptoms alone are a poor indicator of bacterial infection. A semi-quantitative examination of a Gram-stained sputum preparation was the best indicator of bacterial infection. This finding may have relevance in the design of clinical trials of antibacterial drugs in AECB.
authors.affiliation: Postgraduate Medical School, Manor Park, University of Surrey, Guildford, UK. carol.burley@micron-research.com
authors.forename: C J
authors.initials: CJ
authors.lastname: Burley
authors.forename: R G
authors.initials: RG
authors.lastname: Masterton
authors.forename: D P
authors.initials: DP
authors.lastname: Lovell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D001431:Bacteriological Techniques / Q000592:standards*; D029481:Bronchitis, Chronic / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D002986:Clinical Trials as Topic; D018450:Disease Progression; D004417:Dyspnea / Q000473:pathology; D005260:Female; D005840:Gentian Violet; D006801:Humans; D008297:Male; D008875:Middle Aged; D010619:Phenazines; D012680:Sensitivity and Specificity; D013183:Sputum / Q000166:cytology / Q000382:microbiology*; D013194:Staining and Labeling; D013492:Suppuration / Q000473:pathology
chemical_list: C035863:Gram's stain; D010619:Phenazines; D005840:Gentian Violet