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PLoS One. 2014 Sep 26;9(9):e108523. doi: 10.1371/journal.pone.0108523. eCollection 2014.

Bacterial distribution in the lungs of children with protracted bacterial bronchitis.

Author information

1
Academic Department of Child Health, University Hospital of North Staffordshire, Stoke on Trent, United Kingdom.
2
Paediatric Intensive Care, University Hospital of North Staffordshire, Stoke on Trent, United Kingdom.
3
Academic Department of Child Health, University Hospital of North Staffordshire, Stoke on Trent, United Kingdom; Institute of Science and Technology in Medicine, Keele University, Keele, United Kingdom.

Abstract

OBJECTIVES:

Flexible bronchoscopy with bronchoalveolar lavage (FB-BAL) is increasingly used for the microbiological confirmation of protracted bacterial bronchitis (PBB) in children with a chronic wet cough. At our centre, when performing FB-BAL for microbiological diagnosis we sample 6 lobes (including lingula) as this is known to increase the rate of culture positive procedures in children with cystic fibrosis. We investigated if this is also the case in children with PBB.

METHODS:

We undertook a retrospective case note review of 50 children investigated for suspected PBB between May 2011 and November 2013.

RESULTS:

The median (IQR) age at bronchoscopy was 2.9 (1.7-4.4) years and the median (IQR) duration of cough was 11 (8.0-14) months. Positive cultures were obtained from 41/50 (82%) and 16 (39%) of these patients isolated ≥2 organisms. The commonest organisms isolated were Haemophilus influenzae (25 patients), Moraxella catarrhalis (14 patients), Staphylococcus aureus (11 patients) and Streptococcus pneumoniae (8 patients). If only one lobe had been sampled (as per the European Respiratory Society guidance) 17 different organisms would have been missed in 15 patients, 8 of whom would have had no organism cultured at all. The FB-BAL culture results led to an antibiotic other than co-amoxiclav being prescribed in 17/41 (41%) patients.

CONCLUSIONS:

Bacterial distribution in the lungs of children with PBB is heterogeneous and organisms may therefore be missed if only one lobe is sampled at FB-BAL. Positive FB-BAL results are useful in children with PBB and can influence treatment.

PMID:
25259619
PMCID:
PMC4178164
DOI:
10.1371/journal.pone.0108523
[Indexed for MEDLINE]
Free PMC Article

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