Epithelial Cells Count and the Ratio of Leukocytes and Epithelial Cells as the Criteria to Determine Qualified Specimen for Community-Acquired Pneumonia (CAP)-causing Pathogens Identification

Ade Dharmawan, Anis Karuniawati, Pratiwi Pudjilestari Sudarmono, Delly Chipta Lestari, Cleopas Martin Rumende

Abstract


BACKGROUND: Community-acquired pneumonia (CAP) is the most common infectious with serious rate of morbidity and mortality. Recent conventional method only described 30-50% of CAP etiology. Sputum specimen quality assessment is important to obtain an accessible CAP-causing pathogens identification.

METHODS: This was a prospective descriptive study involving 100 specimens from CAP-diagnosed subjects in Budhi Asih Regional General Hospital inpatien t
care. We assessed three gram-staining criteria for specimen quality determination, and continued by bacterial identification.

RESULTS: All specimens were qualified according to criteria II, while only 94 and 96 specimens were qualified according to criteria I and III, respectively. Sixty-five specimens could be identified by culture and pneumoCLART polymerase chain reaction (PCR) examination, and the 35 specimens remained unknown. Ten out of those 35 specimens were positive after analyzed by Acid-fast Bacilli (AFB) test. The pathogens we identified including Klebsiella pneumoniae (29.6%), Acinetobacter baumanii (10.2%), Enterobacter cloacae (4.6%), Pseudomonas aeruginosa (4.6%), Staphyloccocus aureus (4.6%), Moraxella catarrhalis (3.7%), Enterobacter aerogenes (2.8%), Escherichia coli (2.8%), Streptococcus pneumoniae (1.9%), Mycoplasma pneumoniae (1.9%) and Citrobacter koseri (0.9%).

CONCLUSION: There were no significant differences among the three criteria for sputum specimen quality assessment, based on culture and pneumoCLART examination. We suggest that criteria II could be used to avoid many specimen rejections while good quality specimens still attained for accessible bacteria identification.

KEYWORDS: community-acquired pneumonia, sputum, gram stain, pathogens, bacteria


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References


Grosso A, Famiglietti A, Luna C. Community-acquired pneumonia due to gram-negative bacteria. Community Acquir Infect. 2015; 2:117, CrossRef.

Peto L, Nadjm B, Horby P, Ngan TT, van Doorn R, Van Kinh N, et al. The bacterial aetiology of adult community-acquired pneumonia in Asia: A systematic review. Trans R Soc Trop Med Hyg. 2014; 108: 326-37, CrossRef.

Soepandi PZ, Burhan E, Nawas A, Giriputro S, Isbaniah F, Agustin H et al. Perhimpunan Dokter Paru Indonesia. 2nd ed. Jakarta: Badan Penerbit FKUI; 2014.

Watkins RR, Lemonovich TL. Diagnosis and management of community-acquired pneumonia in adults. Clin Chest Med. 2011; 83: 1299-306, PMID.

Anand N, Kollef MH. The alphabet soup of radiotherapy. Semin Respir Crit Med. 2009; 30: 39, CrossRef.

Farida H, Gasem MH, Suryanto A, Keuter M, Zulkarnain N, Satoto B, et al. Viruses and gram-negative bacilli dominate the etiology of community-acquired pneumonia in Indonesia, a cohort study. Int J Infect Dis. 2015; 38: 101-7, CrossRef.

Holter JC, Müller F, Bjørang O, Samdal HH, Marthinsen JB, Jenum PA, et al. Etiology of community-acquired pneumonia and diagnostic yields of microbiological methods: a 3-year prospective study in Norway. BMC Infect Dis. 2015; 15: 64, CrossRef.

Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015; 373: 415-27, CrossRef.

Naderi H, Sheybani F, Sarvghad M, Meshkat Z, Nooghabi MJ. Etiological diagnosis of community-acquired pneumonia in adult patients: A prospective hospital-based study in Mashhad, Iran. Jundishapur J Microbiol. 2015; 8(8): e22780, CrossRef.

Cağlayan Serin D, Pullukçu H, Ciçek C, Sipahi OR, Taşbakan S, Atalay S. Bacterial and viral etiology in hospitalized community acquired pneumonia with molecular methods and clinical evaluation. J Infect Dev Ctries. 2014; 8: 510-8, CrossRef.

Fukuyama H, Yamashiro S, Kinjo K, Tamaki H, Kishaba T. Validation of sputum gram stain for treatment of communityacquired pneumonia and healthcare-associated pneumonia: a prospective observational study. BMC Infect Dis. 2014; 14: 534, CrossRef.

Mariraj J, Asangi SY, Krishna S, Sonth SB, Ramesh, Shanmugum. Sputum gram stain assessment in relation to sputum culture for respiratory tract infections in a Tertiary Care Hospital. J Clin Diagnostic Res. 2011; 5: 1699-700, article.

Garcia LS, Isenberg HD. Clinical Microbiology Procedures Handbook. Vol 1. Sterling: American Society for Microbiology; 2010, NLMID.

Leber AL. Clinical Microbiology Procedures Handbook. 4th ed. Washington DC: ASM PRESS; 2016, NLMID.

Mokkapati A, Yalamanchili M. Correlation of sputum gram’ s stain and culture in lower respiratory tract infections. OSR-JDMS. 2013; 8: 6-9, article.

Musher DM, Montoya R, Wanahita A. Diagnostic value of microscopic examination of gram-stained sputum and sputum cultures in patients with bacteremic pneumococcal pneumonia. Clin Infect Dis. 2004; 39: 165-9, CrossRef.

Lloveras JJ, Shukr MI, Pinos C, Lindoulsi PG. Usefulness of sputum gram stain and culture for diagnosis of pneumonia in a geriatric institution. J IMAB. 2010; 16(3): 20-22, CrossRef.

Miyashita N, Shimizu H, Ouchi K, Kawasaki K, Kawai Y, Obase Y, et al. Assessment of the usefulness of sputum gram stain and culture for diagnosis of community-acquired pneumonia requiring hospitalization. Med Sci Monit. 2008; 14: CR171-6, PMID.

García-Vázquez E, Marcos MA, Mensa J, de Roux A, Puig J, Font C, et al. Assessment of the usefulness of sputum culture for diagnosis of community-acquired pneumonia using the PORT predictive scoring system. Arch Intern Med. 2004; 164: 1807-11, CrossRef.

Shrestha R, Paudel N, Barakoti B, Dhungana D, Sharma P. Etiology and clinical profile of inpatients with Community acquired pneumonia in Manipal Teaching hospital, Pokhara, Nepal. Nepal J Med Sci. 2012; 1: 84-8, CrossRef.

Faisal F, Burhan E, Aniwidyaningsih W, Kekalih A. Penilaian respons pengobatan empiris pada pasien rawat inap dengan pneumonia komunitas. J Respir Indo. 2014; 34: 60-70, article.

Mulyadi, Asmaila N, Yurikno A. Etiology and Risk Factors for Community Acquired Pneumonia in Dr. Zainoel Abidin Hospital, Banda Aceh. Folia Medica Indones. 2011; 47: 127-9, article.

Rammaert B, Goyet S, Beauté J, Hem S, Te V, Try PL, et al. Klebsiella pneumoniaerelated community-acquired acute lower respiratory infections in Cambodia: Clinical characteristics and treatment. BMC Infect Dis. 2012; 12: 3, CrossRef.

Johansson N, Kalin M, Tiveljung-lindell A, Giske CG, Hedlund J. Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods. Clin Infect Dis. 2010; 50: 202-9, CrossRef.

Wattanathum A, Chaoprasong C, Nunthapisud P, Chantaratchada S, Limpairojn N, Jatakanon A, et al. Community-acquired pneumonia in Southeast Asia: The microbial differences between ambulatory and hospitalized patients. Chest. 2003; 123: 1512-9, CrossRef.

Lauderdale TL, Chang FY, Ben RJ, Yin HC, Ni YH, Tsai JW, et al. Etiology of community acquired pneumonia among adult patients requiring hospitalization in Taiwan. Respir Med. 2005; 99: 1079-86, CrossRef.

Farida H, Severin JA, Gasem MH, Keuter M, Wahyono H, van den Broek P, et al. Nasopharyngeal carriage of Streptococcus pneumonia in pneumonia-prone age groups in Semarang, Java Island, Indonesia. PLoS One. 2014; 9: 16-8, CrossRef.

Safari D, Harimurti K, Khoeri MM, Waslia L, Mudaliana S, A'yun HQ, et al. Staphylococcus aureus and Streptococcus pneumoniae prevalence among elderly adults in Jakarta, Indonesia. Southeast Asian J Trop Med Public Health. 2015; 46: 465-71, PMID.

Farida H, Severin JA, Gasem MH, Keuter M, van den Broek P, Hermans PW, et al. Nasopharyngeal carriage of klebsiella pneumoniae and other gram-negative bacilli in pneumonia-prone age groups in semarang, indonesia. J Clin Microbiol. 2013; 51: 1614-6, CrossRef.

Kashyap S, Sarkar M. Mycoplasma pneumonia : Clinical features and management. Lung India. 2010; 27: 75, CrossRef.

Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007; 44(Supplement 2): S27-72, CrossRef.




DOI: https://doi.org/10.18585/inabj.v12i1.873

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