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Updated: Aug 12, 2025
Bronchoalveolar Lavage BAL for Research; Obtaining Adequate Sample Yield
Published on: March 24, 2014
Pathogenic bacteria in bronchoalveolar lavage cultures and pediatric laryngotracheal reconstruction outcomes
Taylor B Teplitzky1, Yann-Fuu Kou1,2, Kubra M Bozkanat3
1Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Insights
Treating pathogenic bacteria found in bronchoalveolar lavage (BAL) cultures before pediatric double stage laryngotracheal reconstruction (dsLTR) did not significantly alter infection or decannulation rates. This suggests BAL screening remains valuable for surgical preparation in children.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
- Infectious Diseases
Background:
- Pathogenic bacteria are frequently detected in bronchoalveolar lavage (BAL) cultures of children awaiting double stage laryngotracheal reconstruction (dsLTR).
- The clinical significance of treating these infections prior to dsLTR is not well-established.
Purpose of the Study:
- To investigate whether antibiotic treatment for pathogenic bacteria identified in BAL cultures impacts postoperative outcomes in pediatric dsLTR patients.
- To evaluate the effect of presurgical BAL culture treatment on infection rates and tracheostomy decannulation.
Main Methods:
- A retrospective case series with chart review was conducted at a tertiary children's hospital.
- Children under 18 undergoing dsLTR between 2016-2022 with pre-operative BAL cultures were included.
- Outcomes assessed included 30-day postoperative infections and 12-month tracheostomy decannulation rates.
Main Results:
- Of 27 children, 56% had positive BAL cultures, with Pseudomonas aeruginosa and MRSA being most common.
- All positive cultures were treated; postoperative infections occurred in 22% of patients.
- Decannulation rates at 12 months were similar between treated and untreated groups (47% vs. 58%, p=0.70).
Conclusions:
- Pathogenic bacteria are prevalent in BAL cultures before dsLTR in tracheostomy-dependent children.
- Treatment of these bacteria did not significantly change postoperative infection or decannulation rates compared to untreated patients.
- Flexible bronchoscopy and BAL remain beneficial for surgical preparation, guiding management decisions.
Objective:
The primary objective was to determine if treating pathogenic bacteria in bronchoalveolar lavage (BAL) cultures improves outcomes after pediatric double stage laryngotracheal reconstruction (dsLTR).
Study Design:
Case series with chart review.
Setting:
Tertiary children's hospital.
Methods:
All children (<18 years) obtaining flexible bronchoscopy with BAL cultures before dsLTR between 2016 and 2022 were included. Cultures identified abnormal bacterial growth or normal respiratory flora. Thirty-day postoperative surgical site or lung infections were captured and tracheostomy decannulation rates were obtained for children with at least 12 months of follow-up.
Results:
Twenty-seven children obtained presurgical BAL cultures before dsLTR. Median age at reconstruction was 2.9 years (interquartile range: 2.3-3.5) and 89% (24/27) had high grade subglottic stenosis. Positive cultures were obtained in 56% of children (N = 15) with Pseudomonas aeruginosa (40%, 6/15) and methicillin-resistant Staphylococcus aureus (33%, 5/15) the most frequent organisms. All children with positive cultures were treated based on culture and sensitivity data. Postoperative infections developed in 22% (6/27) of children with equal distribution of surgical site and respiratory infections among children with pathogenic bacteria and normal respiratory flora. At 12 months after surgery, the decannulation rate was no different between those treated and not treated for a presurgical positive BAL culture (47% vs. 58%, p = 0.70).
Conclusion:
Pathogenic bacteria are common in BAL cultures from tracheostomy-dependent children before dsLTR. Treatment keeps respiratory infections and decannulation rates similar to children with negative cultures, suggesting continued benefit of flexible bronchoscopy and BAL in preparation for these surgeries.
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