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Seo, Hwang, Sung, Kim, Do, Hur, Lim, Hong, Kim, Jeon, Jegal, Choi, Kwon, Jeong, and Ahn: Bacteriologic Analysis of Expectorated Sputum in Patient with Bronchiectasis
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 67(6): 517-527.

Published online: 31 December 2009

DOI: https://doi.org/10.4046/trd.2009.67.6.517

Bacteriologic Analysis of Expectorated Sputum in Patient with Bronchiectasis

Kwang Won Seo, M.D.1, Se Jin Hwang, M.D.1, Shi Jung Sung, M.D.1, Se Jin Kim, M.D.1, Gi Won Do, M.D.1, Seong Jae Hur, M.D.1, Kyung Hun Lim, M.D.1, Soon-Hyung Hong, M.D.1, Dong Min Kim, M.D.1, Jae Bum Jeon, M.D.1, Yangjin Jegal, M.D.1, Seung Won Choi, M.D.1, Woon Jung Kwon, M.D.2, Joseph Jeong, M.D.3, Jong-Joon Ahn, M.D.1

1Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

2Department of Diagnostic Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

3Department of Laboratory Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

Address for correspondence: Jong-Joon Ahn, M.D. Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3, Jeonhadong, Dong-gu, Ulsan 682-714, Korea. Phone: 82-52-250-8870, Fax: 82-52-251-8235, jjahn@uuh.ulsan.kr

Received 7 September 2009       Accepted 6 October 2009

Copyright©2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

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

Figures and Tables

Figure 1
Total patients with isolated P. aeruginosa. Black bar (■) represents adequate sputum specimen (AS) and white bar (□) represents inadequate sputum specimen (IS). No: number.
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Figure 2
Antimicrobial resistance in the P. aeruginosa isolates for each antibiotics (◆). AMK: amikin; ATM: aztreonam; FEP: cefepime; CTZ: ceftazidime; CIP: ciprofloxacin; GEN: gentamicin; IMP: imipenem; PIP: piperacillin; TCA: Ticarcillin+Clavulanate; TOB: tobramycin.
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Figure 3
Antimicrobial resistance in the K. pneumoniae isolates for each antibiotics (●). AMK: amikin; AMP: ampicillin; AMP/SBT: ampicillin/sulbactam; ATM: aztreonam; CFZ: cefazolin; FEP: cefepime; CFX: cefoxitin; CFT: ceftriaxone; CIP: ciprofloxacin; ESBL: extended spectrum β-lactamase; GEN: gentamicin; IMP: imipenem; PIP/TZC: piperacillin/tazocin; TOB: tobramycin.
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Table 1
Baseline characteristics of the 111 patients evaluated
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No: number; SD: standard deviation; AS: adequate sputum specimen; ICU: intensive care unit; adm: admission.

*Range, 19~06.

Table 2
Microorganisms isolated in sputum specimens
trd-67-517-i002

AS: adequate sputum specimen; IS: inadequate sputum specimen; RRM: removal of repeated microorganisms that were cultured from same patient; PPMs: potentially pathogenic microorganisms; Non-PPMs: non-potentially pathogenic microorganisms; MRSA: Methicillin resistant Staphylococcus aureus ; MSSA: Methicillin sensitive Staphylococcus aureus.

*Streptococcus haemolyticus 1, Aeromonas hydrophilia 1, Candida albicans 1, Citrobacter braakii 1, Enterobacter amnigenus 1, Klebsiella oxytoca 1, Moraxella species 1, Serratia marcescens 1, Stenotrophomonas maltophilia 1, Streptococcus agalactiae 1, Streptococcus dysgalactiae 1, †Corynebacterium xerosis 1, Klebsiella oxytoca 1, Moraxella species 1, ‡Streptococcus haemolyticus 1, Stenotrophomonas maltophilia 1, Serratia marcescens 1, Enterobacter amnigenus 1, Citrobacter braakii 1, Candida albicans 1, Aeromonas hydrophilia 1, Streptococcus agalactiae 1, Streptococcus dysgalactiae 1, §Aeromonas hydrophilia 1, Candida albicans 1, Citrobacter braakii 1, Enterobacter amnigenus 1, Klebsiella oxytoca 1, Moraxella species 1, Serratia marcescens 1, Stenotrophomonas maltophilia 1, Streptococcus agalactiae 1, Streptococcus dysgalactiae 1, ∥Corynebacterium xerosis 1, Staphylococcus auricularis 1, Staphylococcus epidermidis 1, Staphylococcus auricularis 1, Staphylococcus epidermidis 1, **Corynebacterium xerosis 1, Staphylococcus auricularis 1, Staphylococcus epidermidis 1, Streptococcus haemolyticus 1.

Table 3
The comparison of patients with adequate sputum specimen and inadequate sputum specimen
trd-67-517-i003

No: number; AS: adequate sputum specimen; IS: inadequate sputum specimen; SD: standard deviation; BE: bronchiectasis; ICU: intensive care unit.

Table 4
The comparison of patients with P. aeruginosa and without P. aeruginosa
trd-67-517-i004

No: number; AS: adequate sputum specimen; SD: standard deviation; BE: bronchiectasis; ICU: intensive care unit.

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