Defining lower airway bacterial infection in children with chronic endobronchial disorders
Identifieur interne : 000B04 ( Main/Merge ); précédent : 000B03; suivant : 000B05Defining lower airway bacterial infection in children with chronic endobronchial disorders
Auteurs : Kim M. Hare ; Susan J. Pizzutto ; Anne B. Chang ; Heidi C. Smith-Vaughan ; Gabrielle B. Mccallum ; Jemima Beissbarth ; Lesley Versteegh ; Keith GrimwoodSource :
- Pediatric Pulmonology [ 8755-6863 ] ; 2017.
Abstract
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.
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).
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.
Our findings support a BAL threshold ≥104 CFU/mL to define lower airway infection in children with chronic endobronchial disorders.
Url:
DOI: 10.1002/ppul.23931
PubMed: 29265639
PubMed Central: 7167837
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PMC:7167837Le document en format XML
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<series><title level="j">Pediatric Pulmonology</title>
<idno type="ISSN">8755-6863</idno>
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<front><div type="abstract" xml:lang="en"><title>Abstract</title>
<sec id="ppul23931-sec-0001"><title>Background</title>
<p>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.</p>
</sec>
<sec id="ppul23931-sec-0002"><title>Methods</title>
<p>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 × 10<sup>3</sup>
cells/mL) and airway neutrophilia (neutrophils >15% BAL leukocytes).</p>
</sec>
<sec id="ppul23931-sec-0003"><title>Results</title>
<p>From 2007 to 2016, 655 children with PBB, CSLD, or bronchiectasis were enrolled. In univariate analyses, Indigenous status and bacterial load ≥10<sup>5</sup>
colony‐forming units (CFU)/mL were positively associated with high TCCs. Viruses and bacterial load ≥10<sup>4</sup>
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 ≥10<sup>4</sup>
CFU/mL and with neutrophilia at ≥10<sup>5</sup>
CFU/mL; GMs of TCCs and neutrophil counts were significantly elevated at 10<sup>4</sup>
and 10<sup>5</sup>
CFU/mL compared to negative cultures.</p>
</sec>
<sec id="ppul23931-sec-0004"><title>Conclusions</title>
<p>Our findings support a BAL threshold ≥10<sup>4</sup>
CFU/mL to define lower airway infection in children with chronic endobronchial disorders.</p>
</sec>
</div>
</front>
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