Diagnostic Accuracy of Nasopharyngeal Swab Cultures in Children Less Than Five Years with Chronic Wet Cough
Background: It is necessary to find a non-invasive and accurate procedure to predict persistent bacterial bronchitis (PBB) causative organisms and guide antibiotic therapy. The study objective was to compare the diagnostic accuracy of nasopharyngeal swab cultures with bronchoalveolar lavage (BAL) cu...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-12-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/8/12/1161 |
| _version_ | 1797505832895643648 |
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| author | Ali A. Asseri Nasim Khattab Dima Ezmigna Nabil J. Awadalla Cori Daines Wayne Morgan |
| author_facet | Ali A. Asseri Nasim Khattab Dima Ezmigna Nabil J. Awadalla Cori Daines Wayne Morgan |
| author_sort | Ali A. Asseri |
| collection | DOAJ |
| description | Background: It is necessary to find a non-invasive and accurate procedure to predict persistent bacterial bronchitis (PBB) causative organisms and guide antibiotic therapy. The study objective was to compare the diagnostic accuracy of nasopharyngeal swab cultures with bronchoalveolar lavage (BAL) cultures in children with PBB. Methods: Nasopharyngeal swab and BAL fluid specimens were collected and cultured for bacterial pathogens prospectively from less than five-year-old children undergoing flexible bronchoscopy for chronic wet cough. Results: Of the 59 children included in the study, 26 (44.1%) patients had a positive BAL bacterial culture with neutrophilic inflammation. Prevalence of positive cultures for any of the four common respiratory pathogens implicated in PBB (<i>Moraxella catarrhalis</i>, <i>Streptococcus pneumoniae</i>, <i>Staphylococcus aureus</i>, and <i>Haemophilus influenzae</i>) was significantly higher (<i>p</i> = 0.001) in NP swabs compared to BAL fluids (86.4% and 44.1% of PBB cases, respectively). NP swab cultures for any of the four main bacterial pathogens had 85% (95% CI: 65–96%) and 48% (95% CI: 31–66%) sensitivity and specificity of detecting PBB, respectively. Positive and negative predictive values were 56% (95% CI: 47–65%) and 80% (95% CI: 60–91%), respectively. In conclusion, in children less than 5 years of age with chronic wet cough (PBB-clinical), a negative NP swab result reduces the likelihood of lower airway infection; however, a positive NP swab does not accurately predict the presence of lower airway pathogens. Flexible bronchoscopy should be considered in those with recurrent PBB-clinical or with clinical pointers of central airway anomalies. |
| first_indexed | 2024-03-10T04:23:58Z |
| format | Article |
| id | doaj.art-81f52f51f9214d208dfadc0fe672f8b8 |
| institution | Directory Open Access Journal |
| issn | 2227-9067 |
| language | English |
| last_indexed | 2024-03-10T04:23:58Z |
| publishDate | 2021-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj.art-81f52f51f9214d208dfadc0fe672f8b82023-11-23T07:42:47ZengMDPI AGChildren2227-90672021-12-01812116110.3390/children8121161Diagnostic Accuracy of Nasopharyngeal Swab Cultures in Children Less Than Five Years with Chronic Wet CoughAli A. Asseri0Nasim Khattab1Dima Ezmigna2Nabil J. Awadalla3Cori Daines4Wayne Morgan5Department of Pediatrics, King Khalid University, Guraiger, Abha 62529, Saudi ArabiaDepartment of Pediatrics, The University of Arizona, Tucson, AZ 85724, USADepartment of Pediatrics, University of Florida, Gainesville, FL 32611, USADepartment of Family and Community Medicine, College of Medicine, King Khalid University, Abha 62529, Saudi ArabiaDepartment of Pediatrics, The University of Arizona, Tucson, AZ 85724, USADepartment of Pediatrics, The University of Arizona, Tucson, AZ 85724, USABackground: It is necessary to find a non-invasive and accurate procedure to predict persistent bacterial bronchitis (PBB) causative organisms and guide antibiotic therapy. The study objective was to compare the diagnostic accuracy of nasopharyngeal swab cultures with bronchoalveolar lavage (BAL) cultures in children with PBB. Methods: Nasopharyngeal swab and BAL fluid specimens were collected and cultured for bacterial pathogens prospectively from less than five-year-old children undergoing flexible bronchoscopy for chronic wet cough. Results: Of the 59 children included in the study, 26 (44.1%) patients had a positive BAL bacterial culture with neutrophilic inflammation. Prevalence of positive cultures for any of the four common respiratory pathogens implicated in PBB (<i>Moraxella catarrhalis</i>, <i>Streptococcus pneumoniae</i>, <i>Staphylococcus aureus</i>, and <i>Haemophilus influenzae</i>) was significantly higher (<i>p</i> = 0.001) in NP swabs compared to BAL fluids (86.4% and 44.1% of PBB cases, respectively). NP swab cultures for any of the four main bacterial pathogens had 85% (95% CI: 65–96%) and 48% (95% CI: 31–66%) sensitivity and specificity of detecting PBB, respectively. Positive and negative predictive values were 56% (95% CI: 47–65%) and 80% (95% CI: 60–91%), respectively. In conclusion, in children less than 5 years of age with chronic wet cough (PBB-clinical), a negative NP swab result reduces the likelihood of lower airway infection; however, a positive NP swab does not accurately predict the presence of lower airway pathogens. Flexible bronchoscopy should be considered in those with recurrent PBB-clinical or with clinical pointers of central airway anomalies.https://www.mdpi.com/2227-9067/8/12/1161bacterial pathogensbronchoalveolar lavage (BAL)chronic wet coughnasopharyngeal swabpersistent bacterial bronchitis (PBB) |
| spellingShingle | Ali A. Asseri Nasim Khattab Dima Ezmigna Nabil J. Awadalla Cori Daines Wayne Morgan Diagnostic Accuracy of Nasopharyngeal Swab Cultures in Children Less Than Five Years with Chronic Wet Cough Children bacterial pathogens bronchoalveolar lavage (BAL) chronic wet cough nasopharyngeal swab persistent bacterial bronchitis (PBB) |
| title | Diagnostic Accuracy of Nasopharyngeal Swab Cultures in Children Less Than Five Years with Chronic Wet Cough |
| title_full | Diagnostic Accuracy of Nasopharyngeal Swab Cultures in Children Less Than Five Years with Chronic Wet Cough |
| title_fullStr | Diagnostic Accuracy of Nasopharyngeal Swab Cultures in Children Less Than Five Years with Chronic Wet Cough |
| title_full_unstemmed | Diagnostic Accuracy of Nasopharyngeal Swab Cultures in Children Less Than Five Years with Chronic Wet Cough |
| title_short | Diagnostic Accuracy of Nasopharyngeal Swab Cultures in Children Less Than Five Years with Chronic Wet Cough |
| title_sort | diagnostic accuracy of nasopharyngeal swab cultures in children less than five years with chronic wet cough |
| topic | bacterial pathogens bronchoalveolar lavage (BAL) chronic wet cough nasopharyngeal swab persistent bacterial bronchitis (PBB) |
| url | https://www.mdpi.com/2227-9067/8/12/1161 |
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