The Science Journal of the American Association for Respiratory Care

1995 OPEN FORUM Abstracts

RESULTS OF MULTIPLE SEQUENTIAL SPUTUM INDUCTIONS ON THE DIAGNOSIS OF PNEUMOCYSTIS PNEUMONIA

William T. Peruzzi, MD; Suellen G. Moen, BSN; Mary Weinert, MD; Lance Peterson, MD; Brian L. Smith, RRT; Robert Hirschtick, MD. Northwestern University, Chicago, Illinois

Information was collected to determine the number of induced sputum samples necessary for definitive diagnosis of Pneumocystis carinii pneumonia (PCP).

Over a 5 month period, sputum inductions were monitored and data collected on all patients being evaluated for PCP in a large university hospital and AIDS treatment center. The diagnostic protocol required three sequential inductions followed by individual direct fluorescent antibody (DFA) stains (Genetic Systems^{TM}, Seattle, WA) on each sample. Once twenty patients tested positive for PCP, the study was concluded.

A total of 92 patients (102 admissions) were evaluated. Thirty seven (36%) of the admitting diagnoses were presumed PCP, 26 (26%) were pneumonia, and the remaining 39 (38%) admissions had diagnoses not related to PCP or pneumonia. A total of 297 sputum inductions were performed. Fifty seven (19%) of the inductions did not result in adequate sputum samples due to collection errors, patient refusal of the induction procedure, nonproductive inductions, or the quantity was not sufficient. When appropriate samples were obtained, 193 (65%) were negative for PCP and 47 (16%) were positive. Of the 20 patients positive for PCP, 19 were positive on the first adequate sputum sample; only 1 tested negative on the first adequate sample and was positive on the second sample. Three patients had an initial positive result followed by negative results after approximately 35-45 hours of antimicrobial therapy.

Our data support that one sputum induction is sufficient to definitively determine whether the patient is positive or negative for PCP. If the first technically adequate sputum induction is negative, bronchoscopy should be the next step in evaluation if the diagnosis of PCP is still in question.

OF-95-105

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