Accuracy of Gram's stain in identifying pneumococci in sputum

Rein, Michael F.; Gwaltney, Jack M.; O’Brien, William M.; Jennings, Robert H.; Mandell, Gerald L.

doi:10.1001/jama.239.25.2671

Cited by 111 publications

(39 citation statements)

References 14 publications

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“…Gram staining of respiratory tract secretions has been used as a first-line diagnostic test for many years [50]. It has been found to be relatively sensitive and specif ic in community-acquired pneumonia [51], with a sen sitivity of 62% and a specificity of 85% in pneumococ cal disease [52], While its further continued use is en couraged, its diagnostic accuracy has been questioned [53,54]. We have identified a number of additional and simple laboratory investigations which may aid differential diagnosis, the most significant of these be ing the platelet count.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Bacteraemic Community-Acquired Lobar Pneumonia due to Streptococcus pneumoniae and Klebsiella pneumoniae in an Intensive Care Unit

et al. 1991

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In a study of 41 consecutive patients with bacteraemia-associated community-acquired lobar pneumonia due to Streptococcus pneumoniae and Klebsiella pneumoniae an attempt was made to determine whether distinguishing criteria of disease due to these organisms could be identified according to demographic features and the results of initial clinical and laboratory investigations. Such information would aid in the early initiation of appropriate antimicrobial therapy. The most significant difference between the two groups of patients was the lower platelet count in the K pneumoniae group (p < 0.005). In addition leucopenia (p < 0.05), higher serum albumin (p < 0.05), and the male sex (p < 0.05) featured with an increased frequency in patients with pulmonary infection due to K. pneumoniae. Initial antimicrobial therapy in critically ill patients with community-acquired lobar pneumonia and thrombocytopenia, particularly when associated with leucopenia and in male patients, should include agents effective against K. pneumoniae

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Section: Discussionmentioning

confidence: 99%

Comparison of Bacteraemic Community-Acquired Lobar Pneumonia due to Streptococcus pneumoniae and Klebsiella pneumoniae in an Intensive Care Unit

et al. 1991

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“…Definitive diagnosis, however, must await results of a culture of properly obtained sputum, blood, or transtracheal aspirate. In some cases, a presumptive diagnosis may be based on the analysis of a Gram stain of expectorated sputum or a transtracheal aspirate (4,29,47,57,62). However, sputum smears rmay be difficult to interpret due to contamination with oral flora or the presence of more than one potential pathogen or may be unavailable due to dehydration or the inability of the patient to cooperate.…”

mentioning

confidence: 99%

Ampicillin versus cefamandole as initial therapy for community-acquired pneumonia

Weber¹,

Calderwood²,

Karchmer³

et al. 1987

Antimicrob Agents Chemother

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“…Sputum was cultured if possible. Smears were stained using Gram’s method and bacterial morphology was determined [17, 18]. Semiquantitative counting was carried out on positive cultures [19].…”

Section: Methodsmentioning

confidence: 99%

Treatment of Community-Acquired Pneumonia in Outpatients: Randomized Study of Clarithromycin Alone versus Clarithromycin and Cefuroxime

Rovira

Martínez‐Moragón²,

Belda³

et al. 1999

Respiration

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Objective: To evaluate the efficacy of clarithromycin alone in comparison with the combination of clarithromycin and cefuroxime in the treatment of nonhospitalized patients with community-acquired pneumonia (CAP) in a Mediterranean population. Methods: CAP was defined as the acute onset of fever (>38°C) with pulmonary opacity on chest roentgenogram. The American Thoracic Society (ATS) criteria (1993) were used to decide on patient hospitalization. Ninety subjects, of whom 53 (59%) were men, with a mean age (± SD) of 38 ± 15 years, were randomized: 45 received clarithromycin 500 mg b.i.d. orally for 14 days (CL group), and 45 received clarithromycin plus cefuroxime 500 mg b.i.d. orally for 7 days (CLCE group). Patients were monitored with clinical, radiological, and laboratory controls at 3 and 21 days. There were no significant differences between the two groups with regard to demographic, clinical, physical and laboratory data. Results: The mean time to defervescence was 2.4 ± 1.4 and 2.4 ± 1.5 days, respectively. Chest roentgenogram clearance was complete in all cases, without statistically significant differences in the time to resolution between both arms. Side effects were mild (no significant differences between groups): 5 patients in the CL group and 3 in the CLCE group showed gastrointestinal symptoms. Two patients (2.2%), both in the CLCE group, needed hospital admission during follow-up, but all 90 patients showed an excellent outcome. A causative agent was determined in 25 cases (28%). Legionella pneumophila, Streptococcus pneumoniae, and Mycoplasma pneumoniae were the most frequent pathogens. Conclusion: Empirical treatment of outpatient CAP with clarithromycin can be considered adequate in the Mediterranean area, independently of the microbiological etiology. ATS criteria for admitting patients with CAP are appropriate in this population.

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Accuracy of Gram's stain in identifying pneumococci in sputum

Cited by 111 publications

References 14 publications

Comparison of Bacteraemic Community-Acquired Lobar Pneumonia due to <i>Streptococcus pneumoniae</i> and <i>Klebsiella pneumoniae</i> in an Intensive Care Unit

Comparison of Bacteraemic Community-Acquired Lobar Pneumonia due to <i>Streptococcus pneumoniae</i> and <i>Klebsiella pneumoniae</i> in an Intensive Care Unit

Ampicillin versus cefamandole as initial therapy for community-acquired pneumonia

Treatment of Community-Acquired Pneumonia in Outpatients: Randomized Study of Clarithromycin Alone versus Clarithromycin and Cefuroxime

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