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Sputum for C&S

Gary Lum glum at ozemail.com.au
Sat May 27 06:42:23 EST 2000

Tracy wrote:

> I listened to a talk from a respiratory Dr. who thinks sputum for C&S is
> a useless test and should not be done, because it is always full of
> normal respiratory flora and very difficult to pick out the pathogen.
> He said an X-ray is the better thing to go by.
> I am looking for proof or any articles written about this.

I wouldn't say sputum for microscopy, culture and susceptibility testing is
always useless.  But pretty close to useless in some contexts.  Even if you
screen using a Gram's stain and try to correlate the microscopy with the
culture result, the vast majority of specimens we receive (hospital and
community work) aren't particularly clinically useful in terms of results.
Whereas someone with clinical signs and symptoms of acute pneumonia with a
consistent chest x-ray is pretty informative.  It's horses for course, I'd
never dismiss the value of a well collected sputum in a patient actually
productive of sputum, however, the clinical, radiological and
microbiological information all have to be interpreted together.  In our
area where melioidosis is common, the chest x-ray is important, but it's the
culture that's vital.  However, we frequently receive poorly collected
collected specimens and the microscopy does not reveal the typical
gram-negative safety-pin shaped bacillus with bipolar staining consistent
with Burkholderia pseudomallei.  Given the most common cause of pneumonia
worldwide is Streptococcus pneumoniæ and that laboratories are pretty poor
at culturing the organism from well collected sputa, it's no wonder some
requesting medical practitioners dismiss the value of sputum for m/c/s.



Dr Gary Lum, Director of Pathology, Territory Health Services
Rocklands Drive, Tiwi NT 0810, Australia
Tel. 61889228034, Mob. 61419814490, Fac. 61889228843
mailto:glum at ozemail.com.au
Helping requesting practitioners to answer their diagnostic
questions, not just doing pathology tests.

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