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Expectorated Sputum for Community-Acquired Pneumonia
A Sacred Cow
Arch Intern Med. 2004;164:1725-1727.
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For the diagnosis and management of community-acquired pneumonia, the routine gram staining and culture of expectorated sputum is a hallowed, time-honored tradition of dubious value. The overall recent trend has been, finally, to relegate this sacred cow of a test to the quaint pastures of history, but some steadfastly cling, with purple-stained fingers, to the hope that expectorated sputum analysis, as it is currently applied, can somehow reliably improve clinical decisions when managing patients with community-acquired pneumonia. The usefulness of this test in the management of community-acquired pneumonia has never been convincingly demonstrated in a clinical setting, and today the article García-Vázquez and colleagues1 again underscore that point.
Recent trends that favor a diminished role for sputum gram staining and culture in management algorithms and all the attendant controversies are well reflected in 2 major practice guidelines.2-3 The American Thoracic Society (ATS) guidelines, with which we agree, do not recommend . . . [Full Text of this Article]
J. Mark Madison, MD;
Richard S. Irwin, MD
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