1
|
Schultz A, Balaguruswamy S, Dentice R, Dobler CC, Geake J, Gibson P, Goulter P, Jayaram L, Laird PJ, Middleton PG, Seale H. Thoracic Society of Australia and New Zealand position statement: The safe clinical use of sputum induction for bio-sampling of the lower airways in children and adults. Respirology 2024; 29:372-378. [PMID: 38556839 DOI: 10.1111/resp.14707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/11/2024] [Indexed: 04/02/2024]
Abstract
Sputum induction is widely used in clinical settings for collection of biological samples from the lower airways. However, in recent years sputum induction has been associated with serious adverse events and even death. This position statement was commissioned by the Thoracic Society of Australia and New Zealand to address major adverse events of two deaths associated with sputum induction that have occurred in Australia in 2021, and outlines best practice for the safe use of sputum induction. The statement resulted from systematic literature searches by a multi-disciplinary group including respiratory physicians, nurses and physiotherapists (paediatric and adults focused). Consumers had input to an advanced draft of the position statement. The position statement covers indications for sputum induction, informed consent, scope of practice of personnel administering the procedure, infection control considerations, details about the sputum induction procedure, safety considerations and risk assessment in clinical settings.
Collapse
Affiliation(s)
- André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia
- Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Sathya Balaguruswamy
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Ruth Dentice
- Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Claudia C Dobler
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
- Department of Respiratory Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - James Geake
- Department of Thoracic and Sleep Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Peter Gibson
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Patricia Goulter
- Physiotherapy Department, Te Whatu Ora (Health New Zealand), Wellington, New Zealand
| | - Lata Jayaram
- Department of Respiratory and Sleep Medicine, Western Health, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Victoria, Australia
| | - Pamela J Laird
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia
- Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department Physiotherapy, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Peter G Middleton
- Westmead Clinical School, University of Sydney, Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Helen Seale
- Department of Physiotherapy, The Prince Charles Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
2
|
Butov D, Feshchenko Y, Myasoedov V, Kuzhko M, Gumeniuk M, Gumeniuk G, Tkachenko A, Nataliya N, Borysova O, Butova T. Effectiveness of inhaled hypertonic saline application for sputum induction to improve Mycobacterium tuberculosis identification in patients with pulmonary tuberculosis. Wien Med Wochenschr 2021; 172:261-267. [PMID: 34383222 DOI: 10.1007/s10354-021-00871-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study assessed the effectiveness and diagnostic significance of hypertonic saline sputum induction for improving Mycobacterium tuberculosis (MTB) detection. METHODS A prospective, randomized, open, two-arm, comparative study on MTB identification effectiveness when using inhaled sodium chloride hypertonic solution was performed in patients diagnosed with pulmonary tuberculosis (TB). Patients were randomly assigned into two groups: group 1 (inhalation group) included patients who inhaled a 7% sodium chloride solution upon admission to the hospital, and group 2 (control group) coughed up their sputum as usual. For both groups, specimens were tested by bacterioscopic, bacteriological, and molecular genetic methods. Diagnostic chest radiography was performed for all participants. RESULTS In this study, 644 patients (mean age 42.2 years; 151 women, 23.4%) were randomly divided into two groups. Low-quality sputum samples were observed in 7.4% of patients from the inhalation group and 28.8% in the control group (p < 0.001). Acid-fast bacilli (AFB) smear was positive in 65.1% of patients from the inhalation group and 51.3% of controls (p = 0.002). A similar statistically significant situation was observed when culture methods (93.9% inhalation group and 81.9% control group, p < 0.001) and molecular genetic tests (92.2% inhalation group and 79.4% control group, p < 0.001) were used. Thus, active pulmonary TB was not verified microbiologically in 6.1% of patients from the inhalation group and in 18.1% of controls (p < 0.001). CONCLUSIONS Hypertonic saline sputum induction improves the quality of collected samples. This method may be appropriate to increase the rate of MTB detection in sputum using microscopic, bacteriological, and molecular genetic methods for diagnosing TB on the day of specimen collection. Hypertonic saline sputum induction is suitable for middle- and low-income countries with limited resources and causes no severe adverse effects in TB patients.
Collapse
Affiliation(s)
- Dmytro Butov
- Departments of Phthisiology and Pulmonology, Kharkiv National Medical University, 4 Nauky Avenue, 61022, Kharkiv, Ukraine.
| | - Yurii Feshchenko
- National Institute of Phthisiology and Pulmonology named after F. G. Yanovskyi NAMS of Ukraine, Kyiv, Ukraine
| | - Valeriy Myasoedov
- Departments of Phthisiology and Pulmonology, Kharkiv National Medical University, 4 Nauky Avenue, 61022, Kharkiv, Ukraine
| | - Mykhailo Kuzhko
- National Institute of Phthisiology and Pulmonology named after F. G. Yanovskyi NAMS of Ukraine, Kyiv, Ukraine
| | - Mykola Gumeniuk
- National Institute of Phthisiology and Pulmonology named after F. G. Yanovskyi NAMS of Ukraine, Kyiv, Ukraine
| | - Galyna Gumeniuk
- National Institute of Phthisiology and Pulmonology named after F. G. Yanovskyi NAMS of Ukraine, Kyiv, Ukraine
| | - Anton Tkachenko
- Departments of Phthisiology and Pulmonology, Kharkiv National Medical University, 4 Nauky Avenue, 61022, Kharkiv, Ukraine
| | - Nekrasova Nataliya
- Departments of Phthisiology and Pulmonology, Kharkiv National Medical University, 4 Nauky Avenue, 61022, Kharkiv, Ukraine
| | - Olena Borysova
- Departments of Phthisiology and Pulmonology, Kharkiv National Medical University, 4 Nauky Avenue, 61022, Kharkiv, Ukraine
| | - Tetiana Butova
- Departments of Phthisiology and Pulmonology, Kharkiv National Medical University, 4 Nauky Avenue, 61022, Kharkiv, Ukraine
| |
Collapse
|
3
|
[Respiratory isolation in suspected tuberculosis with negative direct sputum examination]. Rev Mal Respir 2019; 36:396-404. [PMID: 30902444 DOI: 10.1016/j.rmr.2018.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 08/09/2018] [Indexed: 11/23/2022]
Abstract
Airborne isolation is the main confinement measure used to limit human-to-human transmission of tuberculosis. If implemented early, precisely as soon as the patient is clinically diagnosed with tuberculosis, this measure will protect the population, particularly the health workers who are exposed. A patient suspected of being infected with tuberculosis can create a difficult situation if microbiological examination of his respiratory secretions is negative. This is a complex laboratory technique and sensitivity varies from one test to another. Thus, a false negative result is possible; meaning that a patient can have positive results on a microbiological culture performed later. This patient would still have low, but not no, contagiousness as long as a treatment has not been initiated. This situation can extend the period of respiratory isolation while further diagnostic investigations are carried out. This extended isolation can reduce the quality of health care delivered and patients can show signs of depression and anxiety. The use in routine clinical investigation of gene amplification tools should allow a rethinking of respiratory isolation rules. These tools, which are very sensitive and with a short reporting time, could drastically reduce the duration of respiratory isolation for patients suspected of being infected with tuberculosis.
Collapse
|