Critical Care: Critical Care in the ICU |

Clinical Impact of Sputum Culture in Critically Ill Patients With Non-Ventilator-Associated Nosocomial Pneumonia FREE TO VIEW

Nobuhiro Ariyoshi, MD; Josef Lassan, MD; Gehan Devendra
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John A. Burns School of Medicine University of Hawaii, Honolulu, HI

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):227A. doi:10.1016/j.chest.2016.08.240
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SESSION TITLE: Critical Care in the ICU

SESSION TYPE: Original Investigation Poster Discussion

PRESENTED ON: Monday, October 24, 2016 at 12:00 PM - 01:30 PM

PURPOSE: To determine the clinical impact of the timing of sputum culture collection in non-ventilator-associated nosocomial pneumonia.

METHODS: We conducted a retrospective study of adult patients with non-ventilator-associated nosocomial pneumonia in a medical ICU at a tertiary academic medical center from January 1, 2013 to December 31, 2014. Patients were followed for sputum sample collection for a maximum of 3 days (72 hours). Analysis method used was logistic regression model. Results were expressed as odds ratios with 95% confidence interval.

RESULTS: A chart review revealed that 108 cases of non-ventilator-associated nosocomial pneumonia were admitted to the medical ICU during a 2-year period. Sputum samples were obtained in 39.8% of patients before antibiotic initiation and were not obtained in 13.9% of patients within 3-day of antibiotics treatment. Good quality sputum samples were obtained in 18.5% of patients. Sputum cultures were positive in 39.8% of patients. In multivariate analysis, both the timing (0-72 hours) and quality of sputum sample were associated with positive culture results (timing: OR 0.92, 95% CI = 0.85-0.96; p < 0.05) (quality: OR 15.74, 95% CI = 3.68-119.43; p < 0.05) and de-escalation rate (timing: OR 0.94, 95% CI = 0.89-0.98; p < 0.05) (quality: OR 6.09, 95% CI = 2.00-21.41; p < 0.05). They were not associated with the duration of antibiotics treatment, hospital-free days (HFDs), ICU-free days (IFDs), ventilator-free days (VFDs), pneumonia recurrence, ICU or hospital re-admission, or mortality.

CONCLUSIONS: Delayed or inadequate quality sputum sample collection were not associated with increasing morbidity or mortality, but associated with lower rate of positive culture results and de-escalation.

CLINICAL IMPLICATIONS: Appropriate sputum collection may improve culture results and de-escalation rate.

DISCLOSURE: The following authors have nothing to disclose: Nobuhiro Ariyoshi, Josef Lassan, Gehan Devendra

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