Cost-effectiveness of sputum culture for patients infected with HIV and community-acquired pneumonia in the emergency department

Perelló R, Miró O, Marcos MA, Bragulat E, Sánchez M, Moreno Docón A

Objectives: To assess the diagnostic cost-effectiveness of sputum culture (SC) for microbiological

diagnosis of community-acquired pneumonia (CAP) in HIV-infected patients

in the Emergency Department.

Patients and methods: Two-year and six month prospective study conducted in a

third level referral Academic Hospital. All the HIV-diagnosed patients with CAP were included

in the study. A sample of sputum was collected from every patient. If the sputum

sample was of good quality according to Murray’s criteria, the culture was done.

The study variables were: gender, number of CD4 limphocytes, viral load, C-reactive

protein (RCP), number of leukocytes, APACHE scale values in admission and highly active

antiretroviral treatment (HAART). Statistical analysis was performed with the SPSS

statistical package (SPSS, version 14.0).

Results: A total of 120 consecutive HIV-patients with CAP were enrolled and in 91 of

them sputum culture was done. Organisms were present in 25 samples. The species

isolated were: S. pneumoniae in 20 cases, H. influenzae in 4, and S. aureus in one case.

There was no significant associations between the study variables and SC positivity.

Conclusion: The cost-effectiveness of SC for etiological diagnosis of CAP in HIV-patients

is similar to the reported in previous literature. The positivity of SC is independent from

the analyzed variables. SC is a useful test in HIV-patients with CAP. Among patients

with positive test results the prevalence of S. pneumoniae is higher.

Bragulat E, Marcos MA, Miró O, Moreno Docón A, Perelló R, Sánchez M