Defining lower airway bacterial infection in children with chronic endobronchial disorders

Autor: Heidi C. Smith-Vaughan, Jemima Beissbarth, Keith Grimwood, Anne B. Chang, Susan J. Pizzutto, Kim M. Hare, Gabrielle B. McCallum, Lesley A. Versteegh
Rok vydání: 2017
Předmět:
Pulmonary and Respiratory Medicine
Male
Microbiological culture
Cystic Fibrosis
Neutrophils
bronchiectasis
Cystic fibrosis
Bronchoalveolar Lavage
03 medical and health sciences
Leukocyte Count
0302 clinical medicine
Bronchoscopy
antibiotic therapy
Medicine
Humans
030212 general & internal medicine
Child
Univariate analysis
Bronchiectasis
medicine.diagnostic_test
business.industry
Infant
Bronchial Diseases
Bacterial Infections
Original Articles
chronic suppurative lung disease
respiratory system
medicine.disease
Neutrophilia
Bacterial Load
respiratory tract diseases
Anti-Bacterial Agents
Bronchoalveolar lavage
030228 respiratory system
Child
Preschool
Pediatrics
Perinatology and Child Health
Immunology
Chronic Disease
Original Article: Respiratory Infections
Respiratory Infections
Respiratory virus
diagnostic threshold
Female
protracted bacterial bronchitis
medicine.symptom
Airway
business
Bronchoalveolar Lavage Fluid
Zdroj: Pediatric Pulmonology
ISSN: 1099-0496
Popis: Background Differentiating lower airway bacterial infection from possible upper airway contamination in children with endobronchial disorders undergoing bronchoalveolar lavage (BAL) is important for guiding management. A diagnostic bacterial load threshold based on inflammatory markers has been determined to differentiate infection from upper airway contamination in infants with cystic fibrosis, but not for children with protracted bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD), or bronchiectasis. Methods BAL samples from children undergoing bronchoscopy underwent quantitative bacterial culture, cytologic examination, and respiratory virus testing; a subset also had interleukin‐8 examined. Geometric means (GMs) of total cell counts (TCCs) and neutrophil counts were plotted by respiratory pathogen bacterial load. Logistic regression determined associations between age, sex, Indigenous status, antibiotic exposure, virus detection and bacterial load, and elevated TCCs (>400 × 103 cells/mL) and airway neutrophilia (neutrophils >15% BAL leukocytes). Results From 2007 to 2016, 655 children with PBB, CSLD, or bronchiectasis were enrolled. In univariate analyses, Indigenous status and bacterial load ≥105 colony‐forming units (CFU)/mL were positively associated with high TCCs. Viruses and bacterial load ≥104 CFU/mL were positively associated with neutrophilia; negative associations were seen for Indigenous status and macrolides. In children who had not received macrolide antibiotics, bacterial load was positively associated in multivariable analyses with high TCCs at ≥104 CFU/mL and with neutrophilia at ≥105 CFU/mL; GMs of TCCs and neutrophil counts were significantly elevated at 104 and 105 CFU/mL compared to negative cultures. Conclusions Our findings support a BAL threshold ≥104 CFU/mL to define lower airway infection in children with chronic endobronchial disorders.
Databáze: OpenAIRE
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