{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T09:45:22Z","timestamp":1775123122880,"version":"3.50.1"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100005224","name":"National Center for Immunization and Respiratory Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005224","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,6,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Diagnostic testing for bacterial etiology of community-acquired pneumonia (CAP) is insensitive. Induced sputum (IS) is an attractive option for the evaluation of the lower respiratory tract.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Children aged 0-18 years with CAP were enrolled in the Etiology of Pneumonia in the Community (EPIC) study between 2010 and 2012. Blood and respiratory specimens were assessed by culture and polymerase chain reaction (PCR). The radiographic CAP was determined by a study radiologist. Sputum was induced with hypertonic saline. IS specimen was high quality (HQ) if Gram stain showed &amp;gt;25 white blood and &amp;lt;10 epithelial cells per low-powered field; all others were low quality (LQ). We compared IS pathogen prevalence between HQ and LQ IS, and by radiographic pneumonia. Pathogen concordance with EPIC etiology was assessed. Length of stay (LOS) was compared by receipt of IS pathogen-concordant antibiotics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Out of 977 children, 916 (94%) children enrolled in Memphis, Tennessee, produced IS; 794 (87%) had radiographic CAP and 174 (19%) were HQ. HQ IS yielded pathogenic bacteria more often than LQ (64% vs 44%; P &amp;lt; .01); however, pathogens were isolated at similar rates in HQ IS in patients with and without radiographic CAP (64% vs. 63%; P = .6). Pathogens from study specimens matched an IS pathogen in only 9\/42 (21%) patients with radiographic CAP. Median LOS was similar among patients with radiographic CAP regardless of receipt of IS pathogen-concordant antibiotics (3.1 days), non-pathogen-concordant antibiotics (2.7 days), or no antibiotics (3.2 days; P = .5).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Bacterial pathogens were isolated from most IS cultures regardless of radiographic CAP and quality of IS. IS cultures infrequently corresponded with sterile site cultures. Isolation of pathogens from pediatric IS reflects oropharyngeal carriage and is insufficient to determine bacterial etiology of CAP.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jpids\/piac014","type":"journal-article","created":{"date-parts":[[2022,2,23]],"date-time":"2022-02-23T20:13:30Z","timestamp":1645647210000},"page":"274-282","source":"Crossref","is-referenced-by-count":7,"title":["Utility of Induced Sputum in Assessing Bacterial Etiology for Community-Acquired Pneumonia in Hospitalized Children"],"prefix":"10.1093","volume":"11","author":[{"given":"Amanda","family":"Green","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Tennessee Health Science Center , Memphis, Tennessee , USA"},{"name":"Department of Infectious Diseases, St. Jude Children\u2019s Research Hospital , Memphis, Tennessee , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jody L","family":"Cockroft","sequence":"additional","affiliation":[{"name":"Institute for Intelligent Systems, University of Memphis , Memphis, Tennessee , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert A","family":"Kaufman","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging, St. Jude Children\u2019s Research Hospital , Memphis, Tennessee , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan A","family":"McCullers","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Tennessee Health Science Center , Memphis, Tennessee , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra R","family":"Arnold","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Tennessee Health Science Center , Memphis, Tennessee , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,4,1]]},"reference":[{"key":"2022062210152652600_CIT0001","volume-title":"Hospital Stays for Children, 2009: Statistical Brief #118, in Healthcare Cost and Utilization Project (HCUP) Statistical Briefs","author":"Yu","year":"2006"},{"key":"2022062210152652600_CIT0002","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1542\/peds.2009-3109","article-title":"National hospitalization trends for pediatric pneumonia and associated complications.","volume":"126","author":"Lee","year":"2010","journal-title":"Pediatrics"},{"key":"2022062210152652600_CIT0003","volume-title":"Costs for Hospital Stays in the United States, 2011: Statistical Brief #168, in Healthcare Cost and Utilization Project (HCUP) Statistical Briefs","author":"Pfuntner","year":"2006"},{"key":"2022062210152652600_CIT0004","volume-title":"Most Frequent Conditions in U.S. Hospitals, 2011: Statistical Brief #162, in Healthcare Cost and Utilization Project (HCUP) Statistical Briefs","author":"Pfuntner","year":"2006"},{"key":"2022062210152652600_CIT0005","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1056\/NEJMoa1405870","article-title":"Community-acquired pneumonia requiring hospitalization among U.S. children.","volume":"372","author":"Jain","year":"2015","journal-title":"N Engl J Med"},{"key":"2022062210152652600_CIT0006","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1017\/S0950268806006157","article-title":"Characteristics of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus isolated from the nasopharynx of healthy children attending day-care centres in the Czech Republic.","volume":"134","author":"Zemlickova","year":"2006","journal-title":"Epidemiol Infect"},{"key":"2022062210152652600_CIT0007","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1038\/ismej.2015.49","article-title":"Culture and molecular-based profiles show shifts in bacterial communities of the upper respiratory tract that occur with age.","volume":"9","author":"Stearns","year":"2015","journal-title":"ISME J"},{"key":"2022062210152652600_CIT0008","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/j.jinf.2015.06.010","article-title":"Nasopharyngeal bacterial burden and antibiotics: influence on inflammatory markers and disease severity in infants with respiratory syncytial virus bronchiolitis.","volume":"71","author":"Suarez-Arrabal","year":"2015","journal-title":"J Infect"},{"key":"2022062210152652600_CIT0009","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1128\/jcm.6.4.396-399.1977","article-title":"Microscopic and bacteriological comparison of paired sputa and transtracheal aspirates.","volume":"6","author":"Geckler","year":"1977","journal-title":"J Clin Microbiol"},{"key":"2022062210152652600_CIT0010","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1086\/318151","article-title":"Prospective study of the usefulness of sputum Gram stain in the initial approach to community-acquired pneumonia requiring hospitalization.","volume":"31","author":"Roson","year":"2000","journal-title":"Clin Infect Dis"},{"key":"2022062210152652600_CIT0011","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1001\/archinte.164.16.1807","article-title":"Assessment of the usefulness of sputum culture for diagnosis of community-acquired pneumonia using the PORT predictive scoring system.","volume":"164","author":"Garcia-Vazquez","year":"2004","journal-title":"Arch Intern Med"},{"key":"2022062210152652600_CIT0012","first-page":"339","article-title":"Microscopic and baceriologic analysis of expectorated sputum.","volume":"50","author":"Murray","year":"1975","journal-title":"Mayo Clin Proc"},{"key":"2022062210152652600_CIT0013","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1093\/cid\/cir625","article-title":"Executive Summary: The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America.","volume":"53","author":"Bradley","year":"2011","journal-title":"Clin Infect Dis"},{"key":"2022062210152652600_CIT0014","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1136\/thx.2008.099051","article-title":"Induced sputum in the diagnosis of childhood community-acquired pneumonia.","volume":"64","author":"Lahti","year":"2009","journal-title":"Thorax"},{"key":"2022062210152652600_CIT0015","doi-asserted-by":"crossref","first-page":"e00245","DOI":"10.1128\/mBio.00245-10","article-title":"Microbial communities of the upper respiratory tract and otitis media in children.","volume":"2","author":"Laufer","year":"2011","journal-title":"mBio"},{"key":"2022062210152652600_CIT0016","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1086\/322048","article-title":"Nasopharyngeal carriage of Streptococcus pneumoniae in Finnish children younger than 2 years old.","volume":"184","author":"Syrjanen","year":"2001","journal-title":"J Infect Dis"},{"key":"2022062210152652600_CIT0017","doi-asserted-by":"crossref","first-page":"S180","DOI":"10.1093\/cid\/cir1070","article-title":"Lower respiratory infections among hospitalized children in New Caledonia: a pilot study for the pneumonia etiology research for child health project.","volume":"54","author":"Mermond","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2022062210152652600_CIT0018","doi-asserted-by":"crossref","first-page":"S280","DOI":"10.1093\/cid\/cix090","article-title":"The diagnostic utility of induced sputum microscopy and culture in childhood pneumonia.","volume":"64","author":"Murdoch","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2022062210152652600_CIT0019","volume-title":"Fundamentals of Biostatistics","author":"Rosner","year":"2011","edition":"7"},{"key":"2022062210152652600_CIT0020","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1093\/jac\/dkf506","article-title":"Dynamics of nasopharyngeal colonization by potential respiratory pathogens.","volume":"50","author":"Garc\u00eda-Rodr\u00edguez","year":"2002","journal-title":"J Antimicrob Chemother"}],"container-title":["Journal of the Pediatric Infectious Diseases Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jpids\/article-pdf\/11\/6\/274\/44161355\/piac014.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jpids\/article-pdf\/11\/6\/274\/44161355\/piac014.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T10:15:51Z","timestamp":1655892951000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jpids\/article\/11\/6\/274\/6562288"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,1]]},"references-count":20,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,4,1]]},"published-print":{"date-parts":[[2022,6,22]]}},"URL":"https:\/\/doi.org\/10.1093\/jpids\/piac014","relation":{},"ISSN":["2048-7207"],"issn-type":[{"value":"2048-7207","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,6,1]]},"published":{"date-parts":[[2022,4,1]]}}}