Bacteriologic Analysis of Expectorated Sputum in Patient with Bronchiectasis

Background: Bronchiectasis (BE) remains a rare respiratory disease in Korea. This retrospective study was done to investigate the potential pathogenic microorganisms (PPMs) that cause in patients with BE, through the use of sputum specimens. Methods: One hundred eleven adult patients, who had undergone chest computed tomography (CT), sputum gram stain/culture, and BE detected by chest CT, were included in this study. Sputum adequacy was determined by using Murray-Washington classification. Results: The mean (±SD) age of patients was 60.9 (±14.0). The number of PPMs was 167 (67%) in the total 248 isolated organisms. The most frequent PPMs were P. aeruginosa (23.4%), K. pneumoniae (10.5%), and S. aureus (8.4%). The proportion of adequate sputum (AS) was 25.8% in the total sputum specimens. The patients with AS were 41 (37%) and the patients with inadequate sputum (IS) were 70 (63%). The proportion of P. aeruginosa was higher in AS compared to that of IS (44% vs. 19%, p=0.004). The BE score was also higher in P. aeruginosa (＋) patients compared to that of P. aeruginosa (−) patients (10.8 vs. 7.6, p=0.001). Conclusion: Although the proportion of AS in the total sputum was low, PPMs were isolated in most patients with BE. It is likely that P. aeruginosa was isolated in AS and AS patients had higher BE scores.

keywords: Bronchiectasis, Sputum, Microbiology, Bacteriology

Reference

Swartz MN. Chapter 132. Bronchiectasis. In: Fishman AP, Elias JA, Fishman JA, Grippi MA, Kaiser LR, Senior RM, editors. Fishman's pulmonary diseases and disorders. 3rd ed. New York: McGraw-Hill; 1998. p.2045-70.

Barker AF. Bronchiectasis. N Engl J Med 2002;346:1383-93.

Rho YH, Kim YW, Park CS, Lee YH, Kim SY, Kim KY, et al. Clinical review of 147 cases of bronchiectasis. Korean J Med 1982;25:155-63.

Chung HY, Cho DI, Yoo JI, Rhu MS. Clinical studies on relationship with sinusitis and bronchiectasis. Tuberc Respir Dis 1978;25:165-9.

Shin YG, Im JS, Choi HH. Clinical study of bronchiectasis. Korean J Thorac Cardiovasc Surg 1993;26:294-7.

Korea National Statistical Office. The annual prevalence day of each chronic illness in Korea (Population per person in 2001) [Internet]. Daejeon: Korea National Statistical Office, c2009. Available from: http://www.kosis.kr/.

Ho PL, Chan KN, Ip MS, Lam WK, Ho CS, Yuen KY, et al. The effect of Pseudomonas aeruginosa infection on clinical parameters in steady-state bronchiectasis. Chest 1998;114:1594-8.

King PT, Holdsworth SR, Freezer NJ, Villanueva E, Holmes PW. Microbiologic follow-up study in adult bronchiectasis. Respir Med 2007;101:1633-8.

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 Suppl 2:S27-72.

10.

Murray PR, Washington JA. Microscopic and baceriologic analysis of expectorated sputum. Mayo Clin Proc 1975;50:339-44.

11.

Geckler RW, Gremillion DH, McAllister CK, Ellenbogen C. Microscopic and bacteriological comparison of paired sputa and transtracheal aspirates. J Clin Microbiol 1977;6:396-9.

12.

Bartlett JG, Dowell SF, Mandell LA, File Jr TM, Musher DM, Fine MJ. Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America. Clin Infect Dis 2000;31:347-82.

13.

Lee JH, Kim YK, Kwag HJ, Chang JH. Relationships between high-resolution computed tomography, lung function and bacteriology in stable bronchiectasis. J Korean Med Sci 2004;19:62-8.

14.

Clarke L, Latta PD. Paratechnical processing of specimens for aerobic bacteriology. In: Isenberg HD, editor. Clinical microbiology procedures handbook. 2nd ed. Washington: ASM Press; 2008. p. 3311-29.

15.

Cabello H, Torres A, Celis R, El-Ebiary M, Puig de la Bellacasa J, Xaubet A, et al. Bacterial colonization of distal airways in healthy subjects and chronic lung disease: a bronchoscopic study. Eur Respir J 1997;10:1137-44.

16.

Murray A, Mostafa S, van Saene H. Essentials in clinical microbiology. In: Soutenbeek CP, van Saene HKF, editors. Baillieres's clinical anaesthesiology. 1st ed. London: Bailliere Tindall; 1991. p. 1-23.

17.

Soler N, Ewig S, Torres A, Filella X, Gonzalez J, Zaubet A. Airway inflammation and bronchial microbial patterns in patients with stable chronic obstructive pulmonary disease. Eur Respir J 1999;14:1015-22.

18.

Chow AW. Chapter 57. Infections of the oral cavity, neck, and head. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas and Bennett's principles and practice of infectious diseases. 6th ed. Philadelphia: Churchill Livingstone; 2005. p. 787-10.

19.

Smith IE, Jurriaans E, Diederich S, Ali N, Shneerson JM, Flower CD. Chronic sputum production: correlations between clinical features and findings on high resolution computed tomographic scanning of the chest. Thorax 1996;51:914-8.

20.

Barker AF, Bardana EJ Jr. Bronchiectasis: update of an orphan disease. Am Rev Respir Dis 1988;137:969-78.

21.

Huang JH, Kao PN, Adi V, Ruoss SJ. Mycobacterium avium-intracellulare pulmonary infection in HIV-negative patients without preexisting lung disease: diagnostic and management limitations. Chest 1999;115:1033-40.

22.

Prince DS, Peterson DD, Steiner RM, Gottlieb JE, Scott R, Israel HL, et al. Infection with Mycobacterium avium complex in patients without predisposing conditions. N Engl J Med 1989;321:863-8.

23.

Lee JY, Song JW, Hong SB, Oh YM, Lim CM, Lee SD, et al. Prevalence of NTM pulmonary infection in the patients with bronchiectasis. Tuberc Respir Dis 2004;57:311-9.

24.

Chung SW, Chung HK. Clinical evaluation of the bronchiectasis. Korean J Thorac Cardiovasc Surg 1995;28:1007-13.

25.

Angrill J, Agusti C, de Celis R, Rano A, Gonzalez J, Sole T, et al. Bacterial colonisation in patients with bronchiectasis: microbiological pattern and risk factors. Thorax 2002;57:15-9.

26.

Nicotra MB, Rivera M, Dale AM, Shepherd R, Carter R. Clinical, pathophysiologic, and microbiologic characterization of bronchiectasis in an aging cohort. Chest1995;108:955-61.

27.

Pasteur MC, Helliwell SM, Houghton SJ, Webb SC, Foweraker JE, Coulden RA, et al. An investigation into causative factors in patients with bronchiectasis. Am J Respir Crit Care Med 2000;162:1277-84.

28.

Laurenzi GA, Potter RT, Kass EH. Bacteriologic flora of the lower respiratory tract. N Engl J Med 1961;265:1273-8.

29.

Sethi S, Sethi R, Eschberger K, Lobbins P, Cai X, Grant BJ, et al. Airway bacterial concentrations and exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007;176:356-61.

30.

Rosell A, Monso E, Soler N, Torres F, Angrill J, Riise G, et al. Microbiologic determinants of exacerbation in chronic obstructive pulmonary disease. Arch Intern Med 2005;165:891-7.

31.

Miravitlles M, Espinosa C, Fernandez-Laso E, Martos JA, Maldonado JA, Gallego M. Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD. Study Group of Bacterial Infection in COPD. Chest 1999;116:40-6.

32.

Soler N, Torres A, Ewig S, Gonzalez J, Celis R, El-Ebiary M, et al. Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation. Am J Respir Crit Care Med 1998;157:1498-505.

33.

Banerjee D, Khair OA, Honeybourne D. Impact of sputum bacteria on airway inflammation and health status in clinical stable COPD. Eur Respir J 2004;23:685-91.

34.

Wilson R. Bacteria, antibiotics and COPD. Eur Respir J 2001;17:995-1007.

35.

Pang JA, Cheng A, Chan HS, Poon D, French G. The bacteriology of bronchiectasis in Hong Kong investigated by protected catheter brush and bronchoalveolar lavage. Am Rev Respir Dis 1989;139:14-7.

36.

Monso E, Ruiz J, Rosell A, Manterola J, Fiz J, Morera J, et al. Bacterial infection in chronic obstructive pulmonary disease. A study of stable and exacerbated outpatients using the protected specimen brush. Am J Respir Crit Care Med 1995;152:1316-20.

37.

Roson B, Carratala J, Verdaguer R, Dorca J, Manresa F, Gudiol F. Prospective study of the usefulness of sputum Gram stain in the initial approach to community- acquired pneumonia requiring hospitalization. Clin Infect Dis 2000;31:869-74.

38.

Hawkey PM. The growing burden of antimicrobial resistance. J Antimicrob Chemother 2008;62 Suppl 1:i1-9.

39.

Costerton JW. The etiology and persistence of cryptic bacterial infections: a hypothesis. Rev Infect Dis 1984;6 Suppl 3:S608-16.

40.

Ceri H, Olson ME, Stremick C, Read RR, Morck D, Buret A. The Calgary Biofilm Device: new technology for rapid determination of antibiotic susceptibilities of bacterial biofilms. J Clin Microbiol 1999;37:1771-6.

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Article Contents

Vol.67 No.6

Bacteriologic Analysis of Expectorated Sputum in Patient with Bronchiectasis

Abstract

Reference

Tuberculosis & Respiratory Diseases