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Bacterial distribution in the lungs of children with protracted bacterial bronchitis

Ravi Narang1, Kelly Bakewell1, Jane Peach1

  • 1Academic Department of Child Health, University Hospital of North Staffordshire, Stoke on Trent, United Kingdom.

Plos One
|September 27, 2014
PubMed

Insights

Sampling multiple lung lobes during flexible bronchoscopy with bronchoalveolar lavage (FB-BAL) increases bacterial detection in children with protracted bacterial bronchitis (PBB). This approach aids in accurate diagnosis and targeted antibiotic treatment for chronic wet cough.

Area of Science:

  • Pediatric Pulmonology
  • Microbiology
  • Respiratory Medicine

Background:

  • Protracted bacterial bronchitis (PBB) is a common cause of chronic wet cough in children.
  • Flexible bronchoscopy with bronchoalveolar lavage (FB-BAL) is increasingly utilized for microbiological diagnosis of PBB.
  • Current guidelines recommend sampling a single lobe, but optimal sampling strategy for PBB is debated.

Purpose of the Study:

  • To investigate whether sampling multiple lung lobes during FB-BAL increases the rate of positive microbiological cultures in children with suspected PBB.
  • To compare the diagnostic yield of multi-lobe versus single-lobe sampling in this pediatric population.

Main Methods:

  • Retrospective case note review of 50 children investigated for suspected PBB.
  • Analysis of microbiological culture results from FB-BAL.
  • Comparison of culture outcomes based on the number of lung lobes sampled.

Main Results:

  • Positive cultures were obtained in 82% of patients, with 39% yielding multiple organisms.
  • Sampling 6 lobes (including lingula) identified more organisms compared to single-lobe sampling.
  • If only one lobe had been sampled, 15 patients would have had missed organisms, and 8 would have had no growth at all.
  • FB-BAL results influenced antibiotic prescribing in 41% of culture-positive cases.

Conclusions:

  • Bacterial distribution in the lungs of children with PBB is heterogeneous.
  • Sampling multiple lung lobes during FB-BAL enhances diagnostic yield and reduces the risk of missed organisms.
  • Positive FB-BAL results are valuable in guiding PBB treatment decisions.
Abstract

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