Clinical Value of Paired Sputum and Transtracheal Aspirates in the Initial Management of Pneumonia

One hundred young adults with acute pneumonia were prospectively studied to determine the impact of the transtracheal aspiration (TTA) Gram stain on immediate management. Sputum and TTA interpretations by staff and housestaff were compared. After a management plan was elected based on sputum Gram stain interpretation, the TTA was evaluated and the final plan chosen. A change in treatment after the TTA was available occurred in eight cases, and this was an appropriate change in only five. The putative pathogen as identified by TTA culture was correctly predicted after sputum Gram stain interpretation in 36 to 62 percent of cases and after TTA interpretation in 37 to 62 percent. This indicates significant observer variation but not superiority of one type of specimen over the other. In most cases, paired sputum and TTA Gram stain were both read correctly or incorrectly. When differences occurred, sputum interpretations were as likely to be correct as were TTA interpretations. The TTA Gram stain offered no advantage over sputum Gram stain in the initial management of acute pneumonia in this young adult military population.