Murdoch David R, Morpeth Susan C, Hammitt Laura L, Driscoll Amanda J, Watson Nora L, Baggett Henry C, Brooks W Abdullah, Deloria Knoll Maria, Feikin Daniel R, Kotloff Karen L, Levine Orin S, Madhi Shabir A, O'Brien Katherine L, Scott J Anthony G, Thea Donald M, Ahmed Dilruba, Awori Juliet O, DeLuca Andrea N, Ebruke Bernard E, Higdon Melissa M, Jorakate Possawat, Karron Ruth A, Kazungu Sidi, Kwenda Geoffrey, Hossain Lokman, Makprasert Sirirat, Moore David P, Mudau Azwifarwi, Mwaba John, Panchalingam Sandra, Park Daniel E, Prosperi Christine, Salaudeen Rasheed, Toure Aliou, Zeger Scott L, Howie Stephen R C
Department of Pathology, University of Otago, and.
Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand.
Clin Infect Dis. 2017 Jun 15;64(suppl_3):S271-S279. doi: 10.1093/cid/cix083.
BACKGROUND.: It is standard practice for laboratories to assess the cellular quality of expectorated sputum specimens to check that they originated from the lower respiratory tract. The presence of low numbers of squamous epithelial cells (SECs) and high numbers of polymorphonuclear (PMN) cells are regarded as indicative of a lower respiratory tract specimen. However, these quality ratings have never been evaluated for induced sputum specimens from children with suspected pneumonia.
METHODS.: We evaluated induced sputum Gram stain smears and cultures from hospitalized children aged 1-59 months enrolled in a large study of community-acquired pneumonia. We hypothesized that a specimen representative of the lower respiratory tract will contain smaller quantities of oropharyngeal flora and be more likely to have a predominance of potential pathogens compared to a specimen containing mainly saliva. The prevalence of potential pathogens cultured from induced sputum specimens and quantity of oropharyngeal flora were compared for different quantities of SECs and PMNs.
RESULTS.: Of 3772 induced sputum specimens, 2608 (69%) had <10 SECs per low-power field (LPF) and 2350 (62%) had >25 PMNs per LPF, measures traditionally associated with specimens from the lower respiratory tract in adults. Using isolation of low quantities of oropharyngeal flora and higher prevalence of potential pathogens as markers of higher quality, <10 SECs per LPF (but not >25 PMNs per LPF) was the microscopic variable most associated with high quality of induced sputum.
CONCLUSIONS.: Quantity of SECs may be a useful quality measure of induced sputum from young children with pneumonia.
实验室评估咳出的痰液标本的细胞质量以检查其是否源自下呼吸道是标准做法。鳞状上皮细胞（SEC）数量少且多形核（PMN）细胞数量多被视为下呼吸道标本的指征。然而，这些质量评级从未在疑似肺炎儿童的诱导痰标本中进行过评估。
我们评估了参与一项关于社区获得性肺炎大型研究的1至59个月住院儿童的诱导痰革兰氏染色涂片和培养物。我们假设与主要含有唾液的标本相比，代表下呼吸道的标本将含有较少量的口咽菌群，并且更有可能以潜在病原体为主。比较了不同数量的SEC和PMN时，从诱导痰标本中培养出的潜在病原体的患病率和口咽菌群的数量。
在3772份诱导痰标本中，2608份（69%）每低倍视野（LPF）的SEC<10个，2350份（62%）每LPF的PMN>25个，这些指标传统上与成人下呼吸道标本相关。以低量口咽菌群的分离和潜在病原体的较高患病率作为高质量的标志物，每LPF<10个SEC（而非每LPF>25个PMN）是与诱导痰高质量最相关的微观变量。
SEC数量可能是肺炎幼儿诱导痰的有用质量指标。
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