Hoppe Jordana E, Towler Elinor, Wagner Brandie D, Accurso Frank J, Sagel Scott D, Zemanick Edith T
Department of Pediatrics, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, Colorado.
Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado.
Pediatr Pulmonol. 2015 Jul;50(7):638-46. doi: 10.1002/ppul.23150. Epub 2015 Jan 7.
Sputum induction is a safe, well tolerated means of obtaining lower airway secretions from children with cystic fibrosis (CF), particularly for assessment of airway inflammation but the clinical value in diagnosing outpatient infections has not been extensively studied.
Investigate the success rate and microbiologic yield of induced sputum (IS) compared to oropharyngeal swabs (OP) and expectorated sputum (ES) samples in children with CF, and determine if IS culture results impact treatment.
Two cohorts were included in this prospective, longitudinal comparative study. In one cohort, simultaneously collected OP, ES, and IS specimens were obtained from 17 CF children at three visits over 1 year. In the second group, sputum induction was performed in 35 CF subjects at four annual visits, and culture results were compared to their nearest respiratory culture within 4 months. Antimicrobial treatment regimens were captured retrospectively.
Sputum induction was successful in 149 of 158 (94%) visit encounters. Polymicrobial infection (combined P = 0.005) and gram negative organisms (combined P = 0.003) were detected more frequently in IS samples compared to OP, as were the individual pathogens Pseudomonas aeruginosa (combined P = 0.04) and Stenotrophomonas maltophilia (combined P = 0.05). The microbiologic yield of serial IS samples collected over 1 year was stable. IS culture results led to antibiotic changes in 6% of visit encounters. However, based on current practice 13% of visits could have resulted in treatment changes.
Sputum induction is feasible in the outpatient setting and appears to improve pathogen detection in children with CF.
痰液诱导是一种安全且耐受性良好的方法，可从囊性纤维化（CF）患儿获取下呼吸道分泌物，尤其用于评估气道炎症，但在诊断门诊感染方面的临床价值尚未得到广泛研究。
研究与口咽拭子（OP）和咳痰（ES）样本相比，CF患儿诱导痰（IS）的成功率和微生物检出率，并确定IS培养结果是否会影响治疗。
这项前瞻性纵向比较研究纳入了两个队列。在一个队列中，在1年的3次就诊时从17名CF患儿中同时采集OP、ES和IS标本。在第二组中，对35名CF受试者进行了4次年度咳痰诱导，并将培养结果与其在4个月内最近的呼吸道培养结果进行比较。回顾性记录抗菌治疗方案。
158次就诊中有149次（94%）痰液诱导成功。与OP相比，IS样本中更频繁地检测到多微生物感染（合并P = 0.005）和革兰氏阴性菌（合并P = 0.003），以及个别病原体铜绿假单胞菌（合并P = 0.04）和嗜麦芽窄食单胞菌（合并P = 0.05）。1年内采集的系列IS样本的微生物检出率稳定。IS培养结果导致6%的就诊时抗生素改变。然而，根据当前的做法，13%的就诊可能会导致治疗改变。
痰液诱导在门诊环境中是可行的，并且似乎可以提高CF患儿的病原体检测率。
