Sputum Gram stain for diagnosing causative bacterial pathogens and guiding antimicrobial therapies in community-acquired pneumonia: a systematic review and meta-analysis protocol
Hiroaki Ogawa1, Georgios D Kitsios2, Mitsunaga Iwata1
1Department of Emergency and General Internal Medicine, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan.
Objectives:
The clinical role of sputum Gram stain for rapid etiologic pathogen diagnosis in patients with community-acquired pneumonia (CAP) remains an unresolved controversy. Variability in protocols and reporting of diagnostic performance in different studies has hampered assessments of clinical utility and interpretation. Since the last meta-analysis published in 1996, several reports and resources to accurately evaluate the diagnostic accuracy of sputum Gram stain have become available. Therefore, we will conduct a systematic review and meta-analysis of the clinical validity and utility of sputum Gram stain.
Methods:
We will search PubMed, Ovid MEDLINE, Embase, and The Cochrane Controlled Register of Trials (CENTRAL) databases from inception through July 30, 2018, with no language restriction and perform a full-text evaluation of potentially relevant articles. We will include prospective and retrospective studies that assess sputum Gram stain in adults (aged ≥18 years) with CAP. Two reviewers will independently extract data and rate each study's validity with standard quality assessment tools. We will subsequently perform standard and latent-class random-effects model meta-analyses to quantitatively synthesize the diagnostic accuracy and yield. Finally, we will assess the totality of evidence by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for diagnostic tests and strategies.
Results:
Results of the analysis will be submitted for publication in a peer-reviewed journal.
Conclusions:
This systematic review and meta-analysis will provide a 30-year synopsis of clinical evidence on sputum Gram stain in patients with CAP.
Insights
This systematic review and meta-analysis will evaluate the clinical utility of sputum Gram stain for diagnosing community-acquired pneumonia (CAP). It synthesizes 30 years of evidence to clarify its role in rapid etiologic pathogen diagnosis.
Area of Science:
- Clinical microbiology and infectious diseases.
- Diagnostic test evaluation and meta-analysis.
Background:
- The diagnostic accuracy and clinical utility of sputum Gram stain for community-acquired pneumonia (CAP) are debated.
- Inconsistent study protocols and reporting have hindered clear interpretation of its effectiveness.
- Recent advancements in diagnostic evaluation necessitate an updated synthesis of evidence.
Purpose of the Study:
- To conduct a systematic review and meta-analysis of the clinical validity and utility of sputum Gram stain for diagnosing CAP.
- To provide a comprehensive 30-year overview of the evidence regarding sputum Gram stain's role in etiologic pathogen diagnosis.
Main Methods:
- Comprehensive literature search of PubMed, Embase, Ovid MEDLINE, and CENTRAL databases (inception to July 2018).
- Inclusion of prospective and retrospective studies on sputum Gram stain in adult CAP patients.
- Data extraction and quality assessment by two independent reviewers, followed by random-effects meta-analysis and GRADE assessment.
Main Results:
- Results will be submitted for publication in a peer-reviewed journal.
- Quantitative synthesis of diagnostic accuracy and yield will be performed.
Conclusions:
- This systematic review and meta-analysis will offer a consolidated 30-year perspective on the clinical evidence for sputum Gram stain in CAP.
- The findings aim to resolve controversies surrounding its role in rapid pathogen identification.
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