Department of Pneumology, Allergy and Neonatology, University Children's Hospital, Hanover Medical School, Hanover, Germany.
PLoS One. 2011;6(11):e27913. doi: 10.1371/journal.pone.0027913. Epub 2011 Nov 29.
Neonates with airways colonized by Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis are at increased risk for recurrent wheeze which may resemble asthma early in life. It is not clear whether chronic colonization by these pathogens is causative for severe persistent wheeze in some preschool children and whether these children might benefit from antibiotic treatment. We assessed the relevance of bacterial colonization and chronic airway infection in preschool children with severe persistent wheezing and evaluated the outcome of long-time antibiotic treatment on the clinical course in such children.
METHODOLOGY/PRINCIPAL FINDINGS: Preschool children (n = 42) with severe persistent wheeze but no symptoms of acute pulmonary infection were investigated by bronchoscopy and bronchoalveolar lavage (BAL). Differential cell counts and microbiological and virological analyses were performed on BAL samples. Patients diagnosed with bacterial infection were treated with antibiotics for 2-16 weeks (n = 29). A modified ISAAC questionnaire was used for follow-up assessment of children at least 6 months after bronchoscopy. Of the 42 children with severe wheezing, 34 (81%) showed a neutrophilic inflammation and 20 (59%) of this subgroup had elevated bacterial counts (≥ 10⁴ colony forming units per milliliter) suggesting infection. Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis were the most frequently isolated species. After treatment with appropriate antibiotics 92% of patients showed a marked improvement of symptoms upon follow-up examination.
CONCLUSIONS/SIGNIFICANCE: Chronic bacterial infections are relevant in a subgroup of preschool children with persistent wheezing and such children benefit significantly from antibiotic therapy.
患有流感嗜血杆菌、肺炎链球菌或卡他莫拉菌气道定植的新生儿发生反复喘息的风险增加，这种反复喘息在生命早期可能类似于哮喘。目前尚不清楚这些病原体的慢性定植是否是导致一些学龄前儿童严重持续性喘息的原因，以及这些儿童是否可能受益于抗生素治疗。我们评估了定植细菌和慢性气道感染在患有严重持续性喘息的学龄前儿童中的相关性，并评估了长期抗生素治疗对这些儿童临床病程的影响。
方法/主要发现：患有严重持续性喘息但无急性肺部感染症状的学龄前儿童（n = 42）接受支气管镜检查和支气管肺泡灌洗（BAL）。对 BAL 样本进行了差异细胞计数以及微生物和病毒学分析。诊断为细菌感染的患者接受了 2-16 周的抗生素治疗（n = 29）。支气管镜检查后至少 6 个月对儿童进行改良 ISAAC 问卷调查，以进行随访评估。在 42 名严重喘息的儿童中，34 名（81%）表现为中性粒细胞炎症，其中 20 名（59%）亚组的细菌计数升高（≥10⁴菌落形成单位/毫升）提示感染。流感嗜血杆菌、肺炎链球菌和卡他莫拉菌是最常分离的物种。经过适当的抗生素治疗，92%的患者在随访检查时症状明显改善。
结论/意义：慢性细菌感染与持续性喘息的学龄前儿童亚群相关，此类儿童从抗生素治疗中获益显著。
