Gram Smear Sputum Critiques
HOME      CONTACT US     EQA PROGRAMS     RESULTS    CRITIQUES     NEWSLETTER     SITE MAP  
To Gram Smear other Samples

Contact us to obtain critiques older than 5 years.
Scroll down to find Critique number of older challenges and a brief description.
Some older archived critiques are included in this list, but CMPT advises visitors to also consult recent literature.
Most recent listed first

Source and expected outcome. To Photo Album Sputum page 1
2010-2011 G101

Sputum from a 64 year old male with community acquired pneumonia (CAP) was sent to category A, B, C and C1 laboratories.

4+ (>25/lpf) neutrophils, no epithelial cells seen, 3+ (11-50/oif) gram negative diplococci/cocci, moderate mucus
2007-2008 G082

Collected from a  45-year old miner with community-acquired pneumonia was sent to category A, B, C, and C1 laboratories.  4+ (>25/lpf) neutrophils, 1+ (1-4/lpf) epithelial cells, 3+ (11-50/oif) gram positive cocci.
Suitability to Culture Interpretation: 74% (53/72) of category A, 52% (16/31) of category B, and 92% (12/13) of category C laboratories received a grade of 4/4.  Cellular Component:  100% (72/72) of category A, 97% (32/33) of category B, and 100% (19/19) of category C laboratories received a grade of 4/4.  (Companion to M082-3 contained multi-resistant strain of S. pneumoniae)gram-positive cocci in pairs or lancet-shaped  (diplococci) or ‘suggestive of S. pneumoniae’ as superior.  There was concern about the reporting of these bacteria as gram-positive cocci ‘suggestive of streptococcus/enterococcus’, because this would be potentially clinically misleading.  While enterococcal pneumonia can be observed as an infection in intensive care units, or in neonates and infants, it is extremely unusual as a cause of community-acquired respiratory infection.
2006-2007 G063

Collected from a 79-year old nursing home resident with a fever and cough being treated with levofloxacin was sent to category A, B, C, and C1 laboratories for Gram staining. It was anticipated that all laboratories would indicate that the sample was suitable for culture, report the presence of neutrophils and gram-positive cocci. The companion sample for culture, M063-3, which contained Streptococcus pneumoniae and Moraxella catarrhalis was sent to category A and B laboratories. In all future sputum Gram smear challenges, a companion culture result WILL NOT be taken as inference of acceptability. Failure to report the Interpretation Component will be negatively graded.
It has previously been raised (see G061 May 2006 ADDENDUM and G043 sputum November 2004 that information of the Gram smear should always be available before the culture result, and since a critical laboratory decision has been made based on the smear, it is imperative that a smear interpretation be provided. Failure to check the suitability of the sample will be considered as a post-analytic reporting error. ) To facilitate proper reporting, CMPT provides a simple checkbox on report forms.
  G061 Sputum smear: 3+ neutrophils, 2+ yeast cells, 3+ gram-negative diplococci – Suitable for culturing. From a 40-year old lymphoma patient, returning from a cross country camping trip. A companion sample for culture was not included in this survey. Participants were expected to stain, read, and interpret the Gram stain, including whether or not the sample was considered suitable for culture.The ability of laboratory personnel to recognize and be able to identify Cryptococcus on the sputum smear is related to the likelihood of infection with the organism in the population in the area the laboratory is situated.
2005-2006 G052 Simulated Bronchial Wash smear: 1+ (0-1/oif) neutrophils, 1+ (0-1/oif) epithelial cells, 3 + (11-50/oif) gram-negative coccobacilli, 1+ (1-5/oif) gram-positive cocci Included a history of being a bronchial wash collected from a 70-year old male with ventilator-associated pneumonia. It was anticipated that all laboratories would stain and report the gram-negative coccobacilli. The companion sample for culture, M052-4, was sent to category A laboratories and contained 4+ Acinetobacter baumannii and 1+ viridans group streptococci. Bacterial component (ungraded): 27/143 (19%) of laboratories reported only gram-positive bacteria. It is important, for the purpose of smear and culture correlation, to recognize Acinetobacter as coccobacilli and different from the typical morphology of Neisseria species or Moraxella species.
2004-2005 G044 Endotracheal aspirate: no neutrophils, rare epithelial cells, 4+ (> 50/ oil immersion field) gram-negative bacilli
This challenge was designed with no neutrophils, trace numbers of epithelial cells, and many (4+) gram-negative bacilli. In the presence of a burn injury this patient would be considered as immunosuppressed, and as such the absence of neutrophils does not necessarily represent absence of infection. This sample could either reflect colonization, or infection. Companion sample M044-2, yielded 4+ Serratia marcescens.
  G043 Sputum smear: 4+ (> 25/low power field) neutrophils, 4+ (> 50/ oil immersion field) gram-negative bacilli/coccobacilli, 2+ (2-10/oif) gram-positive cocciInterpretation: Suitable to culture. M043-3 (companion culture): H. parainfluenzae
2003-2004 G032 Sputum smear:  > 25 neutrophils, < 10 epithelial cells per low power field, 4+ gram-positive cocci in pairs and chains/oil immersion field Interpretation: Suitable to culture. M032-5 Companion culture Streptococcus pneumoniae
2002-2003 G021 Sputum smear: > 25 neutrophils, < 10 epithelial cells/lpf; 4+ gram-positive bacilli (coryneform), 2+ gram-positive cocci/oif   Interpretation: Suitable to culture. M021-4 companion culture (Corynebacterium pseudodiphtheriticum)
2001-2002 G012 Sputum smear: > 25 epithelial cells/lpf, few neutrophils/lpf, heavy mixed oral flora - Interpretation: Unsuitable to culture. M012-2 companion sputum
2000-2001

Introduction of companion Gram smear and culture challenges. 		G24 Sputum smear: Neutrophils and gram-negative coccobacilli (Acinetobacter baumannii) Epithelial cells and bacteria components were graded separately. Participants were expected to make comment of neutrophils and epithelial cells and to correlate Gram smear and culture results. M24-3 companion culture
G23 Sputum smear: Neutrophils, gram-positive bacilli and gram-positive cocci in pairs M23-5, which was the corresponding sample for culture, which contained equal high numbers of Streptococcus pneumoniae and Corynebacterium pseudodiphtheriticum.
1999-2000 G92 Sputum: greater than 25 epithelial cells per low power field, suggesting oral contamination
  G91 Sputum: greater than 25 epithelial cells per low power field, suggesting oral contamination
1998-1999 G81 Sputum: greater than 25 epithelial cells per low power field