Pediatric Pneumology and Cystic Fibrosis Unit, University Clinic Hospital of Valencia, University of Valencia, Av. de Blasco Ibáñez, 13, 46010, Valencia, Spain.
Department of Microbiology, School of Medicine and University Hospital, University of Valencia, Av. de Blasco Ibañez 17, 46010, Valencia, Spain.
Eur J Pediatr. 2018 Feb;177(2):181-192. doi: 10.1007/s00431-017-3044-3. Epub 2017 Dec 29.
This cross-sectional study assessed the prevalence of bacteria isolated from Spanish children with suspected chronic lower respiratory tract infection (LRTI) for whom bronchoalveolar lavage (BAL) was indicated. BAL fluid (BALF) was collected from 191 children (aged ≥ 6 months to < 6 years, with persistent or recurrent respiratory symptoms, non-responders to usual treatment) and cultured. Nasopharyngeal swabs (NPSs) were also obtained and cultured to assess concordance of BALF and NPS findings in the same patient. Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis were identified from BALF with a bacterial load indicative of infection (> 10 colony-forming units/mL) in 10.5, 8.9, and 6.3% of children, respectively. Clinical characteristics were similar among participants, regardless of positivity status for any of the bacteria. Approximately 26% of pneumococcal isolates were PCV13 serotypes, and 96% of H. influenzae isolates were non-typeable (NTHi). Concordance between BALF and NPS isolates was 51.0% for S. pneumoniae, 52.1% for H. influenzae, and 22.0% for M. catarrhalis.
S. pneumoniae, NTHi, and M. catarrhalis were the main bacteria detected in BALF and NPS. Children with suspected chronic LRTI may benefit from a vaccine protecting against NTHi. What is Known: • Chronic lower respiratory tract infection (LRTI) in children can cause high morbidity and is a major use of healthcare resources worldwide. Despite this, their etiology or potential preventive measures are poorly assessed. • Bronchoalveolar lavage can be used to determine bacterial etiology of chronic LRTI. What is New: • We used conventional and molecular techniques to show that Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis were present in the LRT of Spanish children with suspected chronic LRTI • Concordance between isolates from bronchoalveolar lavage fluid and nasopharyngeal swabs was low, suggesting that samples from the upper respiratory tract could not reliably predict the bacterial etiology of suspected chronic LRTI.
本横断面研究评估了西班牙疑似慢性下呼吸道感染（LRTI）患儿的支气管肺泡灌洗液（BAL）分离菌的流行情况。BAL 液（BALF）取自 191 名患儿（年龄≥6 个月至＜6 岁，持续或复发性呼吸道症状，对常规治疗无反应）并进行培养。还采集鼻咽拭子（NPS）并进行培养，以评估同一患者 BALF 和 NPS 结果的一致性。从 BALF 中鉴定出肺炎链球菌、流感嗜血杆菌或卡他莫拉菌，其细菌负荷指示感染（>10 个菌落形成单位/mL）分别占儿童的 10.5%、8.9%和 6.3%。无论任何一种细菌的阳性状态如何，患儿的临床特征相似。约 26%的肺炎球菌分离株为 PCV13 血清型，96%的流感嗜血杆菌分离株为非分型（NTHi）。BALF 和 NPS 分离株的一致性分别为肺炎链球菌 51.0%、流感嗜血杆菌 52.1%和卡他莫拉菌 22.0%。
