Sputum examination in the clinical management of community-acquired pneumonia.
OBJECTIVE
To evaluate the frequency of the use of sputum examination in the clinical management of community-acquired pneumonia (CAP) in a general hospital and to determine whether its use has an impact on mortality.


METHODS
The medical records of CAP patients treated as inpatients between May and November of 2004 at the Nossa Senhora da Conceição Hospital, located in Porto Alegre, Brazil, were reviewed regarding the following aspects: age; gender; severity of pneumonia (Fine score); presence of sputum; sputum bacteriology; treatment history; change in treatment; and mortality.


RESULTS
A total of 274 CAP patients (134 males and 140 females) were evaluated. Using the Fine score to quantify severity, we classified 79 (28.8%) of those 274 patients as class II, 45 (16.4%) as class III, 97 (35.4%) as class IV, and 53 (19.3%) as class V. Sputum examination was carried out in 92 patients (33.6%). A valid sample was obtained in 37 cases (13.5%), and an etiological diagnosis was obtained in 26 (9.5%), resulting in a change of treatment in only 9 cases (3.3%). Overall mortality was 18.6%. Advanced age (above 65), CAP severity, and dry cough were associated with an increase in the mortality rate. Sputum examination did not alter any clinical outcome or have any influence on mortality.


CONCLUSIONS
Sputum examination was used in a minority of patients and was not associated with any noticeable benefit in the clinical management of patients with CAP treated in a hospital setting.
Signori
Leonardo Gilberto Haas
LG
Federal Foundation School of Medical Sciences of Porto Alegre- Porto Alegre, Brazil.
Ferreira
Maurício Weyh
MW
Vieira
Luiz Carlos Hack Radünz
LC
Müller
Karen Reetz
KR
Mattos
Waldo Luís Leite Dias de
WL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D013183:Sputum / Q000382:microbiology*; D015996:Survival Rate
D000900:Anti-Bacterial Agents