Bacteria from bronchoalveolar lavage fluid from children with suspected chronic lower respiratory tract infection: results from a multi-center, cross-sectional study in Spain

Abstract

This cross-sectional study assessed the prevalence of bacteria isolated from Spanish children with suspected chronic lower respiratory tract infection (LRTI) for whom bronchoalveolar lavage (BAL) was indicated. BAL fluid (BALF) was collected from 191 children (aged ≥ 6 months to < 6 years, with persistent or recurrent respiratory symptoms, non-responders to usual treatment) and cultured. Nasopharyngeal swabs (NPSs) were also obtained and cultured to assess concordance of BALF and NPS findings in the same patient. Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis were identified from BALF with a bacterial load indicative of infection (> 104 colony-forming units/mL) in 10.5, 8.9, and 6.3% of children, respectively. Clinical characteristics were similar among participants, regardless of positivity status for any of the bacteria. Approximately 26% of pneumococcal isolates were PCV13 serotypes, and 96% of H. influenzae isolates were non-typeable (NTHi). Concordance between BALF and NPS isolates was 51.0% for S. pneumoniae, 52.1% for H. influenzae, and 22.0% for M. catarrhalis.Conclusion: S. pneumoniae, NTHi, and M. catarrhalis were the main bacteria detected in BALF and NPS. Children with suspected chronic LRTI may benefit from a vaccine protecting against NTHi. What is Known: • Chronic lower respiratory tract infection (LRTI) in children can cause high morbidity and is a major use of healthcare resources worldwide. Despite this, their etiology or potential preventive measures are poorly assessed. • Bronchoalveolar lavage can be used to determine bacterial etiology of chronic LRTI. What is New: • We used conventional and molecular techniques to show that Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis were present in the LRT of Spanish children with suspected chronic LRTI • Concordance between isolates from bronchoalveolar lavage fluid and nasopharyngeal swabs was low, suggesting that samples from the upper respiratory tract could not reliably predict the bacterial etiology of suspected chronic LRTI Electronic supplementary materialThe online version of this article (10.1007/s00431-017-3044-3) contains supplementary material, which is available to authorized users.

Do combined upper airway cultures identify lower airway infections in children with chronic cough?

“…These findings are consistent with previous studies in young children with chronic lower airway disorders including CF and bronchiectasis when using either oropharyngeal or nasopharyngeal swab data alone to predict lower airway infection . Although our data are unique, as we examined both oropharyngeal and nasopharyngeal bacterial cultures and compared them to BAL culture, we found that the combined approach added little to predicting lower airway bacterial infection.…”

“…Staphylococcus aureus , Pseudomonas aeruginosa , and Haemophilus influenzae were the major pathogens in children with CF, and they also predominated in oropharyngeal cultures . In contrast, Streptococcus pneumoniae , H. influenzae , and Moraxella catarrhalis were the main bacteria detected in nasopharyngeal and BAL specimens in children with bronchiectasis and other chronic lower airway infections . A common feature was the poor positive, but high negative predictive values of upper airway cultures for diagnosing lower airway infection.…”

“…Several studies using BAL culture have investigated the diagnostic value of culturing upper airway specimens for identifying lower airway pathogens and infection in children with CF, bronchiectasis, and either acute or chronic lower respiratory infections. Staphylococcus aureus , Pseudomonas aeruginosa , and Haemophilus influenzae were the major pathogens in children with CF, and they also predominated in oropharyngeal cultures .…”

“…To date, there are no published data comparing agreement between nasopharyngeal, oropharyngeal and BAL cultures in children with chronic endobronchial suppuration. Previous studies used either nasopharyngeal or oropharyngeal specimens, but no studies have used both together.…”

Pathogenic characteristics of sputum and bronchoalveolar lavage fluid samples from patients with lower respiratory tract infection in a large teaching hospital in China: a retrospective study

“…Bronchoalveolar lavage fluid (BALF) cultures are a reliable method to determine the bacterial etiology of LRI [ 3 ]. Whether there is a difference between the culture results obtained from sputum samples and BALF is currently unclear.…”