Appropriateness of expectorated sputum cultures in the hospital setting

Sloan, Caroline E.; Bernard, Shaina; Nachamkin, Irving

doi:10.1016/j.diagmicrobio.2015.05.009

Cited by 7 publications

(5 citation statements)

References 13 publications

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“…This is clearly demonstrated in the present study, where 43% (129/298) of the patients initially suspected of pneumonia, subsequently had the diagnosis refuted. Consequently, availability of a rapid molecular syndromic panel test could result in an excessive test ordering practice, if diagnostic guidelines are not followed, as pointed out by Skodvin et al and Sloan et al [29,30].…”

Section: Discussionmentioning

confidence: 99%

Performance of PCR‐based syndromic testing compared to bacterial culture in patients with suspected pneumonia applying microscopy for quality assessment

Andrews

Pinholt

Schneider

et al. 2022

APMIS

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Performance of PCR-based syndromic testing compared to bacterial culture in patients with suspected pneumonia applying microscopy for quality assessment. APMIS. 20222022; 130: 417-426. Syndromic testing for lower respiratory tract infections with BioFireÒ FilmArrayÒ Pneumonia Panel Plus (BF) detects 27 pathogens with a turn-around-time of one hour. We compared the performance of BF with culture. Samples from 298 hospitalized patients with suspected pneumonia routinely sent for culture were also analyzed using BF. Retrospectively, patients were clinically categorized as having "pneumonia" or "no pneumonia." BF and culture were compared by analytical performance, which was evaluated by pathogen concordance, and by clinical performance by comparing pathogen detections in patients with and without pneumonia. The BF results for viruses and atypical bacteria were not included in the performance analysis. In 298 patient samples, BF and culture detected 285 and 142 potential pathogens, respectively. Positive percent agreement (PPA) was 88% (125/142). In patients with community-acquired pneumonia (CAP), clinical sensitivity was 70% and 51%, and specificity was 43% and 71% for BF and culture, respectively. In patients with hospital-acquired pneumonia, the corresponding numbers were 55% and 23%, and 47% and 68%. There was no significant improvement of performance, when only high-quality sputum samples were considered. Efficacy of both BF and culture was low. Both tests are best used in CAP patients for whom the diagnosis has already been clinically established. Indiscriminate use may be clinically misleading and a cause of improper use of antibiotics.

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Section: Discussionmentioning

confidence: 99%

Performance of PCR‐based syndromic testing compared to bacterial culture in patients with suspected pneumonia applying microscopy for quality assessment

Andrews

Pinholt

Schneider

et al. 2022

APMIS

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“…However, the inherent characteristics of the microbiology tests play a major role for the yield; although adhering to the guidelines when sampling specimens, the yield for several tests was low. However, in this study, we did not have information on the quality of sampling and transportation of specimens, which may also impact the yield [8, 25]. Long TATs associated with certain tests may reduce their utility.…”

Section: Discussionmentioning

confidence: 99%

Use of microbiology tests in the era of increasing AMR rates– a multicentre hospital cohort study

Skodvin

Wathne

Lindemann

et al. 2019

Antimicrob Resist Infect Control

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BackgroundEffective use of microbiology test results may positively influence patient outcomes and limit the use of broad-spectrum antibiotics. However, studies indicate that their potential is not fully utilized. We investigated microbiology test ordering practices and the use of test results for antibiotic decision-making in hospitals.MethodsA multicentre cohort study was conducted during five months in 2014 in Medical departments across three hospitals in Western Norway. Patients treated with antibiotics for sepsis, urinary tract infections, skin and soft tissue infections, lower respiratory tract infections or acute exacerbations of chronic obstructive pulmonary disease were included in the analysis. Primary outcome measures were degree of microbiology test ordering, compliance with microbiology testing recommendations in the national antibiotic guideline and proportion of microbiology test results used to inform antibiotic treatment. Data was obtained from electronic- and paper medical records and charts and laboratory information systems.ResultsOf the 1731 patient admissions during the study period, mean compliance with microbiology testing recommendations in the antibiotic guideline was 89%, ranging from 81% in patients with acute exacerbations of chronic obstructive pulmonary disease to 95% in patients with sepsis. Substantial additional testing was performed beyond the recommendations with 298/606 (49%) of patients with lower respiratory tract infections having urine cultures and 42/194 (22%) of patients with urinary tract infections having respiratory tests. Microbiology test results from one of the hospitals showed that 18% (120/672) of patient admissions had applicable test results, but only half of them were used for therapy guidance, i.e. in total, 9% (63/672) of patient admissions had test results informing prescription of antibiotic therapy.ConclusionsThis study showed that despite a large number of microbiology test orders, only a limited number of tests informed antibiotic treatment. To ensure that microbiology tests are used optimally, there is a need to review the utility of existing microbiology tests, test ordering practices and use of test results through a more targeted and overarching approach.

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“…Although potentially beneficial, sputum cultures may not be used to change antibiotic treatment. Studies have suggested that even when cultures were obtained, treatment is often not changed [5,42]. If cultures are obtained, clinicians should use the results within the context of the patient's clinical scenario to guide treatment, as this practice could reduce a patient's LOS and potentially reduce the likelihood of other adverse outcomes for HCAP patients.…”

Section: Discussionmentioning

confidence: 99%

“…Including patients that do not meet these requirements would further decrease the clinical and economic value of sputum cultures. Evidence has shown that these guidelines are often not followed and cultures are submitted unnecessarily [5]. Updated guidelines recommend that empirical coverage for potentially resistant pathogens be based on a narrower set of risk factors [9], which may increase the value of cultures.…”

Section: Discussionmentioning

confidence: 99%

“…Despite numerous studies investigating sputum cultures for pneumonia management, the utility of such cultures remains unclear [1,2], and understanding their economic value may help determine their usefulness. Pneumonia is a leading cause of hospitalization in the US [3,4], and expectorated sputum samples are commonly submitted for diagnostic testing [5]. Sputum cultures may not provide clinically useful information, and adequate collection is challenging [2].…”

Section: Introductionmentioning

confidence: 99%

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The potential economic value of sputum culture use in patients with community-acquired pneumonia and healthcare-associated pneumonia

Asti

Bartsch

Umscheid

et al. 2019

Clinical Microbiology and Infection

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Objective: Despite numerous studies, the clinical value of sputum cultures in the management of pneumonia remains controversial; therefore, understanding the economic value of sputum cultures may help decision makers determine their appropriate use in patient management. Methods: We developed a decision model to determine the economic and clinical value of using sputum cultures in the treatment of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) from the hospital perspective under various conditions. Results: For both CAP and HCAP patients, obtaining sputum cultures resulted in similar costs compared to no culture, even if cultures cost $0. Given current clinical practices, obtaining cultures cost $539e631 more per CAP patient and $13e170 per HCAP patient compared to no culture use. However, cultures saved $8e202 per HCAP patient with a 40% probability the pathogen was the true cause (75% reduction in adverse outcomes, greater length of hospital stay (LOS) increase) to a 70% probability the pathogen was the true cause (25% reduction in outcomes and greater LOS increase and a 75% reduction in outcomes and all LOS increases). Additionally, obtaining sputum cultures had no impact on the number of adverse outcomes (i.e., adverse drug events, Clostridium difficile infection, pneumonia readmissions, additional hospitalization days). When all patients were treated with antibiotics empirically, obtaining cultures saved $4e342. Conclusions: Overall, obtaining sputum cultures does not provide significant clinical or economic benefits for CAP or HCAP patients; however, it can reduce costs and shorten overall LOS under some circumstances. Clinicians should consider their local conditions when making decisions about sputum culture use.

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Appropriateness of expectorated sputum cultures in the hospital setting

Cited by 7 publications

References 13 publications

Performance of PCR‐based syndromic testing compared to bacterial culture in patients with suspected pneumonia applying microscopy for quality assessment

Performance of PCR‐based syndromic testing compared to bacterial culture in patients with suspected pneumonia applying microscopy for quality assessment

Use of microbiology tests in the era of increasing AMR rates– a multicentre hospital cohort study

The potential economic value of sputum culture use in patients with community-acquired pneumonia and healthcare-associated pneumonia

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