Preservation of sputum samples with cetylpyridinium chloride (CPC) for tuberculosis cultures and Xpert MTB/RIF in a low-income country.

Hiza, Hellen; Doulla, Basra; Sasamalo, Mohamed; Hella, Jerry; Kamwela, Lujeko; Mhimbira, Francis; Reither, Klaus; Gagneux, Sebastien; Jugheli, Levan; Fenner, Lukas (2017). Preservation of sputum samples with cetylpyridinium chloride (CPC) for tuberculosis cultures and Xpert MTB/RIF in a low-income country. BMC infectious diseases, 17(1), p. 542. BioMed Central 10.1186/s12879-017-2642-z

Hiza_BMCInfectDis_2017.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (424kB) | Preview


Culture contamination with environmental bacteria is a major challenge in tuberculosis (TB) laboratories in hot and humid climate zones. We studied the effect of cetylpyridinium chloride (CPC) preservation on culture results and performance of Xpert MTB/RIF.


Consecutive sputum samples from microscopy smear-positive TB patients were collected. Two-hundred samples were equally split in two aliquots, one aliquot was treated with CPC and stored at ambient temperature for 7 days. The second aliquot was immediately processed. Samples were decontaminated for 20, 15 or 10 min, and subsequently cultured on Löwenstein-Jensen medium. Furthermore, 50 samples were stored for 7, 14 and 21 days, and 100 CPC-pretreated samples tested by Xpert MTB/RIF.


CPC pretreated samples showed a higher culture yield compared to non-treated sputum samples across all decontamination times: 94% vs. 73% at 10 min (p = 0.01), 94% vs. 64% at 15 min (p = 0.004), and 90% vs. 52% at 20 min (p < 0.001). The quantitative culture grading was consistently higher in CPC treated compared to non-CPC treated samples. The proportion of contaminated cultures was lower in CPC pretreated samples across all decontamination times (range 2-6%) compared to non-CPC treated samples (15-16%). For storage times of CPC treated samples of 7, 14, and 21 days, 84, 86, and 84% of the respective cultures were positive. Of 91 CPC treated samples with a positive culture, 90 were also Xpert MTB/RIF positive.


CPC increases culture yield, decreases the proportion of contamination, and does not alter the performance of Xpert MTB/RIF.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Fenner, Lukas


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services




BioMed Central




Tanya Karrer

Date Deposited:

05 Sep 2017 14:32

Last Modified:

05 Dec 2022 15:07

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

CPC Cetylpyridinium chloride Contamination Culture Low-income country Mycobacterium tuberculosis Preservation Recovery Sample transport Sputum Tuberculosis




Actions (login required)

Edit item Edit item
Provide Feedback