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Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis

Marc Miravitlles, Frank Kruesmann, Daniel Haverstock, Renee Perroncel, Shurjeel H. Choudhri, Pierre Arvis
European Respiratory Journal 2012 39: 1354-1360; DOI: 10.1183/09031936.00042111
Marc Miravitlles
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Frank Kruesmann
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Daniel Haverstock
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Renee Perroncel
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Shurjeel H. Choudhri
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Pierre Arvis
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    Figure 1–

    Percentage of sputum samples with an identified pathogen according to sputum colour. Data in the bars are presented as n/N.

  • Figure 2–
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    Figure 2–

    Distribution of sputum colour by infecting species. a) Haemophilus influenzae, b) Streptococcus pneumoniae, c) Moraxella catarrhalis, d) Haemophilus parainfluenzae, e) Staphylococcus aureus, f) Klebsiella pneumoniae, g) Pseudomonas aeruginosa and h) Haemophilus spp.

Tables

  • Figures
  • Table 1 Designs of the six studies included in the sputum analysis
    Study number [ref.]DesignTreatment (moxifloxacin and comparator)#Patients nPatients with a causative organism n
    84 [6]Prospective, multicentre, multinational, nonblind, randomised study in EuropeMoxifloxacin, 400 mg q.d. for 5 days; amoxicillin/clavulanate, 625 mg t.i.d. for 7 days575251
    100033 [7]Prospective, randomised, double-blind, multicentre study in the USAMoxifloxacin, 400 mg q.d. for 5 days; moxifloxacin, 400 mg q.d. for 10 days; clarithromycin, 500 mg b.i.d. for 10 days926491
    100034¶Prospective, randomised, double-blind, multicentre study in the USA and CanadaMoxifloxacin, 400 mg q.d. for 10 days; moxifloxacin, 200 mg q.d. for 10 days; cefuroxime axetil, 500 mg b.i.d. for 10 days682274
    100160 [8]Prospective, randomised, double-blind, multicentre study in the USA and CanadaMoxifloxacin, 400 mg q.d. for 5 days; azithromycin, 250 mg q.d. (500 mg on day 1) for 5 days567280
    100243 [9]Prospective, randomised, double-blind, multicentre study in the USAMoxifloxacin, 400 mg q.d. for 5 days; levofloxacin, 500 mg q.d. for 7 days594315
    240017 [10]Prospective, randomised, double-blind, multicentre study in EuropeMoxifloxacin, 400 mg q.d. for 5 days; clarithromycin, 500 mg b.i.d. for 7 days745287
    • #: all treatments were administered orally; ¶: data held on file by Bayer Schering Pharma.

  • Table 2– Demographics of patients included in the sputum analysis
    CharacteristicAll patientsPPM positivePPM negativep-value#
    Subjects n408918982191
    Male sex %55.061.049.8<0.001
    Age yrs56±15.355.3±15.557.2±15.0<0.001
    Exacerbations in previous year¶2.5±1.92.4±1.62.5±2.10.614
    Median (IQR) duration of exacerbation before study entry days2 (5)2 (5)2 (6)0.130
    Past or present smoker¶3280 (80.2)1629 (85.8)1651 (75.4)<0.001
    Use of long-term bronchodilators or steroids261 (6.4)116 (6.1)147 (6.7)0.135
    Median (IQR) CRP level¶ mg·L−10.70 (1.79)0.69 (2.17)0.71 (1.56)0.551
    Fever present744 (18.2)294 (15.5)389 (20.5)0.005
    • Data are presented as mean±sd or n (%), unless otherwise stated. PPM: potentially pathogenic microorganism; IQR: interquartile range; CRP: C-reactive protein. #: PPM positive versus PPM negative; ¶: data were not collected for all patients in the study for these characteristics. Cochrane–Mantel–Haenszel test, adjusting for study, categorical variables, and using an ANOVA, also adjusting for study, for the continuous variables.

  • Table 3– Commonly isolated potentially pathogenic microorganisms: number overall and proportion by sputum colour
    MicroorganismTotal isolates nSamples containing specific pathogen# %
    Yellow sputumGreen sputumWhite sputumRust sputum
    Samples of each colour¶ n23191218353113
    Haemophilus influenzae60514.120.010.65.9
    Streptococcus pneumoniae3137.49.512.42.5
    Moraxella catarrhalis3197.311.22.34.4
    Haemophilus parainfluenzae2625.89.22.55.3
    Staphylococcus aureus1583.45.41.75.3
    Klebsiella pneumoniae1333.93.10.81.8
    Pseudomonas aeruginosa1052.43.12.51.8
    Haemophilus spp.+641.42.40.30.0
    Negative culture§219154.541.181.661.1
    • #: percentage of isolates of each species based on the total number of culture samples; ¶: one sample obtained per patient; +: Haemophilus spp. other than H. influenzae and H. parainfluenzae; §: total number of negative cultures.

  • Table 4– Performance parameters of the colour of sputum in the diagnosis of the presence of a potential pathogenic microorganism by study
    Study number [ref.]Sensitivity %Specificity %PPV %NPV %PLRNLR
    84 [6]96.8 (93.8–98.6)4.6 (2.6–7.6)44.1 (39.3–48.4)65.2 (42.7–83.6)1.02 (0.98–1.05)0.68 (0.30–1.59)
    100033 [7]91.8 (88.9–94.0)19.2 (15.6–23.3)56.6 (53.1–60.1)66.9 (57.8–75.2)1.14 (1.08–1.20)0.43 (0.30–0.61)
    100034#95.3 (92.0–97.5)24.4 (20.2–29.0)47.0 (42.8–51.3)88.0 (80.3–93.4)1.26 (1.18–1.34)0.19, (0.11–0.34)
    100160 [8]96.8 (93.9–98.5)16.5 (12.3–21.5)54.1 (49.6–58.6)83.3 (97.7–92.101.16 (1.09–1.23)0.20 (0.10–0.39)
    100243 [9]95.6 (92.7–97.6)13.6 (9.7–18.2)56.1 (51.7–60.3)72.6 (58.3–84.1)1.11 (1.05–1.17)0.33 (0.18–0.59)
    240017 [10]91.1 (87.2–94.2)18.9 (15.4–22.9)41.6 (37.6–45.6)77.1 (68.0–84.6)1.12 (1.06–1.19)0.47 (0.31–0.72)
    Pooled94.8 (92.1–97.4)15.0 (6.7–23.3)NCNCNCNC
    • PPV: positive predictive value; NPV: negative predictive value; PLR: positive likelihood ratio; NLR: negative likelihood ratio; NC: not calculated. #: data held on file by Bayer Schering Pharma.

  • Table 5– Regression analysis of significant factors predicting the presence of potentially pathogenic microorganisms in sputum
    VariableWald Chi-squaredp-valueOR point estimate (95% CI)
    Sputum colour108.4<0.001
     Yellow versus white3.2 (2.3–4.2)
     Green versus white4.9 (3.6–6.8)
     Rust versus white2.3 (1.4–3.7)
    Study32.7<0.001
     84 versus 240017 [6, 10]1.0 (0.8–1.3)
     100033 versus 240017 [7, 10]1.6 (1.3–2.0)
     100034# versus 240017 [10]1.1 (0.8–1.3)
     100160 versus 240017 [8, 10]1.3 (1.0–1.6)
     100243 versus 240017 [9, 10]1.4 (1.1–1.9)
    Sputum aspect27.0<0.001
     Purulent versus mucoid2.0 (1.6–2.5)
     Purulent versus mucopurulent1.1 (1.0–1.2)
     Dyspnoea6.60.036
     Increased versus not increased1.27 (1.1–1.5)
    Sex40.7<0.001
     Male versus female1.5 (1.3–1.8)
    Fever14.80.001
     Absent versus present1.3 (1.1–1.6)
    • #: data held on file by Bayer Schering Pharma.

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Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis
Marc Miravitlles, Frank Kruesmann, Daniel Haverstock, Renee Perroncel, Shurjeel H. Choudhri, Pierre Arvis
European Respiratory Journal Jun 2012, 39 (6) 1354-1360; DOI: 10.1183/09031936.00042111

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Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis
Marc Miravitlles, Frank Kruesmann, Daniel Haverstock, Renee Perroncel, Shurjeel H. Choudhri, Pierre Arvis
European Respiratory Journal Jun 2012, 39 (6) 1354-1360; DOI: 10.1183/09031936.00042111
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