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What is currently the most commonly accepted rejection criteria, as it applies to the evaluation of sputum specimen quality for gram stains? We are currently rejecting sputums with >25 squamous epithelial cells/lpf or <10 pmns/lpf. It has been suggested that this is too lenient, and we should be rejecting specimens with >10 squamous epis.
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There are several scoring systems that have been reported for the rejection of contaminated sputum specimens. Currently the most widely known rejection criteria is that of Bartlett’s grading system:
PMNs/lpf. squamous epithelial cells/lpf Grade
<10 0
10-25 1
>25 2
Mucus 1
10-15 -1
>25 -2
Total Score:
The specimen must have a total score in the positive range to be cultured.
Murray and Washington suggested in their grading scheme that only sputum specimens with <10 epithelial cells lpf and 25 PMNS be cultured. WE use a slight modification of this, as proposed by Van Scoy in which specimens with 10-15 epithelial cells will be cultured if greater then 25 PMNS/lpf are seen. Also if no epithelial cells are seen with no PMN,s in a neutropenic patient, then we will culture this type of specimen. I hope this helps. Most of these systems are more restrictive then what you have been using.
Mike Gaydos
Cleveland VAMC
216 791 3800 x 4920
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