G123

Gram – Sputum: gram negative bacilli, gram positive cocci in chains, >25/lpf neutrophils, 1-9/lpf epithelial cells. Specimen suitable for culture. – Shipped November 2012

HISTORY

A simulated sputum sample obtained from a 43 year old alcoholic male, in-patient, with aspiration pneumonia was sent to category A, B, C, and C1 laboratories. Participants were expected to report the presence of neutrophils, gram negative bacilli, and gram positive cocci. The sample also contained few epithelial cells.

It was expected the participants would indicate that the sample was suitable for culture.

MAIN EDUCATIONAL POINTS from G123

  1. In an alcoholic patient aspiration pneumonia is more common. Mixtures of oropharyngeal or epigastric flora, including gram-negative bacilli and anaerobes may find their way into the lower respiratory tract.
  2. Almost any organism that inhabits the upper airways, including anaerobes, can be aspirated. S. pneumoniae is less common in this setting.

 

Full critique (PDF)

Posted in Clinical Bacteriology Results, critiques, Gram