Gram Stain and Culture of Sputum Samples Detect Only Few Pathogens in Community-Acquired Lower Respiratory Tract Infections: Secondary Analysis of a Randomized Controlled Trial

Author:

Cartuliares Mariana B.12ORCID,Skjøt-Arkil Helene12ORCID,Mogensen Christian B.12ORCID,Skovsted Thor A.3,Andersen Steen L.4,Pedersen Andreas K.25,Rosenvinge Flemming S.67ORCID

Affiliation:

1. Emergency Department, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark

2. Department of Regional Health Research, University of Southern Denmark, 6200 Aabenraa, Denmark

3. Department of Biochemistry and Immunology, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark

4. Department of Clinical Microbiology, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark

5. Department of Clinical Research, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark

6. Department of Clinical Microbiology, Odense University Hospital, 5000 Odense, Denmark

7. Research Unit of Clinical Microbiology, University of Southern Denmark, 5000 Odense, Denmark

Abstract

Identification of the bacterial etiology of lower respiratory tract infections (LRTI) is crucial to ensure a narrow-spectrum, targeted antibiotic treatment. However, Gram stain and culture results are often difficult to interpret as they depend strongly on sputum sample quality. We aimed to investigate the diagnostic yield of Gram stain and culture from respiratory samples collected by tracheal suction and expiratory technique from adults admitted with suspected community-acquired LRTI (CA-LRTI). In this secondary analysis of a randomized controlled trial, 177 (62%) samples were collected by tracheal suction, and 108 (38%) by expiratory technique. We detected few pathogenic microorganisms, and regardless of sputum quality, there were no significant differences between the sample types. Common pathogens of CA-LRTI were identified by culture in 19 (7%) samples, with a significant difference between patients with or without prior antibiotic treatment (p = 0.007). The clinical value of sputum Gram stain and culture in CA-LRTI is therefore questionable, especially in patients treated with antibiotics.

Funder

University of Southern Denmark

University Hospital of Southern Denmark

Knud and Edith Eriksens Mindefond

Fabrikant Mads Clausens Fond

Publisher

MDPI AG

Subject

Clinical Biochemistry

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