Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis.
We examined the correlation between sputum colour and the presence of potentially pathogenic bacteria in acute exacerbations of chronic bronchitis (AECBs). Data were pooled from six multicentre studies comparing moxifloxacin with other antimicrobials in patients with an AECB. Sputum was collected before antimicrobial therapy, and bacteria were identified by culture and Gram staining. Association between sputum colour and bacteria was determined using logistic regression. Of 4,089 sputum samples, a colour was reported in 4,003; 1,898 (46.4%) were culture-positive. Green or yellow sputum samples were most likely to yield bacteria (58.9% and 45.5% of samples, respectively), compared with 18% of clear and 39% of rust-coloured samples positive for potentially pathogenic microorganisms. Factors predicting a positive culture were sputum colour (the strongest predictor), sputum purulence, increased dyspnoea, male sex and absence of fever. Green or yellow versus white sputum colour was associated with a sensitivity of 94.7% and a specificity of 15% for the presence of bacteria. Sputum colour, particularly green and yellow, was a stronger predictor of potentially pathogenic bacteria than sputum purulence and increased dyspnoea in AECB patients. However, it does not necessarily predict the need for antibiotic treatment in all patients with AECB.
Institut d'Investigacions Biomèdiques August Pi i Sunyer, Ciber de Enfermedades Respiratorias, Hospital Clínic, Barcelona, Spain. marcm@separ.es
Marc
M
Miravitlles
Frank
F
Kruesmann
Daniel
D
Haverstock
Renee
R
Perroncel
Shurjeel H
SH
Choudhri
Pierre
P
Arvis
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001372:Aza Compounds / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D029481:Bronchitis, Chronic / Q000188:drug therapy / Q000382:microbiology*; D003116:Color; D018450:Disease Progression; D004417:Dyspnea / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones; D005840:Gentian Violet; D006801:Humans; D008297:Male; D000077266:Moxifloxacin; D015337:Multicenter Studies as Topic; D010619:Phenazines; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000382:microbiology; D011804:Quinolines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012737:Sex Factors; D013183:Sputum / Q000187:drug effects / Q000382:microbiology*
D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; C035863:Gram's stain; D010619:Phenazines; D011804:Quinolines; D005840:Gentian Violet; D000077266:Moxifloxacin