Usefulness of sputum gram stain for etiologic diagnosis in community-acquired pneumonia: a systematic review and meta-analysis.

Autor: Del Rio-Pertuz G; Faculty of Medicine, Division of Health Sciences, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia., Gutiérrez JF; Faculty of Medicine, Division of Health Sciences, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia., Triana AJ; Faculty of Medicine, Division of Health Sciences, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia., Molinares JL; Faculty of Medicine, Division of Health Sciences, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia., Robledo-Solano AB; Faculty of Medicine, Division of Health Sciences, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia., Meza JL; Faculty of Medicine, Division of Health Sciences, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia., Ariza-Bolívar OM; Faculty of Medicine, Division of Health Sciences, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia., Acosta-Reyes J; Faculty of Public Health, Division of Health Sciences, Universidad del Norte, Barranquilla, Colombia., Garavito A; Clínica Medilaser S.A. - Sucursal Florencia, Fundación Universitaria Navarra, Florencia, Colombia., Viasus D; Faculty of Medicine, Division of Health Sciences, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia. dviasus@uninorte.edu.co., Carratalà J; Infectious Disease Department, Hospital Universitari de Bellvitge and Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.; Faculty of Medicine, Clinical Sciences Department, University of Barcelona, Barcelona, Spain.; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0005), Instituto de Salud Carlos III, Madrid, Spain.
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2019 May 10; Vol. 19 (1), pp. 403. Date of Electronic Publication: 2019 May 10.
DOI: 10.1186/s12879-019-4048-6
Abstrakt: Background: Implementation of sputum Gram stain in the initial assessment of community-acquired pneumonia (CAP) patients is still controversial. We performed a systematic review and meta-analysis to investigate the usefulness of sputum Gram stain for defining the etiologic diagnosis of CAP in adult patients.
Methods: We systematically searched the Medline, Embase, Science Direct, Scopus and LILACS databases for full-text articles. Relevant studies were reviewed by at least three investigators who extracted the data, pooled them using a random effects model, and carried out quality assessment. For each bacterium (Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Gram-negative bacilli), pooled sensitivity, specificity, positive and negative likelihood ratios were reported.
Results: After a review of 3539 abstracts, 20 articles were included in the present meta-analysis. The studies included yielded 5619 patients with CAP. Pooled sensitivity and pooled specificity of sputum Gram stain were 0.59 (95% CI, 0.56-0.62) and 0.87 (95% CI, 0.86-0.89) respectively for S. pneumoniae, 0.78 (95% CI, 0.72-0.84) and 0.96 (95% CI, 0.94-0.97) for H. influenzae, 0.72 (95% CI, 0.53-0.87) and 0.97 (95% CI, 0.95-0.99) for S. aureus, and 0.64 (95% CI, 0.49-0.77) and 0.99 (95% CI, 0.97-0.99) for Gram-negative bacilli.
Conclusion: Sputum Gram stain test is sensitive and highly specific for identifying the main causative pathogens in adult patients with CAP.
Trial Registration: This study has been registered at PROSPERO International prospective register of systematic reviews under registration no. CRD42015015337 .
Databáze: MEDLINE
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