Predictive Value of Oropharyngeal Cultures for Identifying Lower Airway Bacteria in Cystic Fibrosis Patients

Ramsey, Bonnie W.; Wentz, Kim R.; Smith, Arnold L.; Richardson, Mark A.; Williams‐Warren, Judy; Hedges, Donna L.; Gibson, Ronald L.; Redding, Gregory J.; Lent, Karen Hoffman; Harris, Kristin

doi:10.1164/ajrccm/144.2.331

Cited by 150 publications

(114 citation statements)

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“…The absence of the pathogen in the culture from the nasopharyngeal aspirate did not exclude the possibility that the pathogen occurred in the lower airways. This finding has also been observed by others [4]. However, the current authors found the ratio of negative Pseudomonas spp.…”

Section: Discussionsupporting

confidence: 91%

“…However, the current authors found the ratio of negative Pseudomonas spp. cultures from the upper airways while positive from the lower to be higher than in studies mentioned previously [4,5]. The fact that a nasopharyngeal aspirate was evaluated whilst other studies have assessed an oropharyngeal swab may explain this difference.…”

Section: Discussionmentioning

confidence: 65%

“…Since oropharyngeal cultures have only a poor positive predictive value [4,5], bronchoalveolar lavage (BAL) remains the standard technique to obtain a lower airway sample in these patients. It is, however, an expensive, time consuming, unpleasant and potentially harmful procedure.…”

mentioning

confidence: 99%

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Sputum induction in young cystic fibrosis patients

Boeck¹,

Alifier²,

Vandeputte³

2000

Eur Respir J

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A culture from the lower airway secretions is the optimal sample to guide antibiotic therapy in cystic fibrosis (CF) lung disease. The authors therefore examined whether sputum induction is an efficient, safe and acceptable procedure in CF children without spontaneous expectorations.Nineteen patients were studied. Their mean age (range) was 8.6 yrs (4.3±15.2 yrs). Their mean forced expiratory volume in one second (FEV1) was 88% predicted (46± 122%). NaCl solutions from 0.9±6% were inhaled, after baseline lung function tests before and after salbutamol.All patients did produce secretions. Alveolar macrophages were present in 16/19 induced samples. The procedure induced minor but significant bronchoconstriction: the mean change (range) in postsalbutamol FEV1 (% pred) was -7 (-24±16). Percutaneous oxygen saturation remained above 90% in all children. The test had to be discontinued in one child because of cough and wheeze. Acceptability of the procedure evaluated using a visual analogue scale from -7±7 showed a mean value (range) at the final concentration of -1.23 (-6.16±5.88).It is concluded that sputum induction is possible, safe and acceptable in cystic fibrosis children who do not expectorate spontaneously. Chronic lower respiratory tract infection is the predominant manifestation of cystic fibrosis (CF). In young CF patients it is important to recognize and treat lung infection as early as possible, since with correct treatment Pseudomonas aeruginosa colonization can be avoided or delayed [1,2]. A culture from the lower airway secretions is necessary to guide antimicrobial therapy. Sputum cultures are considered a valuable substitute for a lower airway sample obtained by bronchoscopy or thoracotomy, since results from both sites will correspond in over 70% of cases [3].Many young CF patients do not produce sputum. Since oropharyngeal cultures have only a poor positive predictive value [4,5], bronchoalveolar lavage (BAL) remains the standard technique to obtain a lower airway sample in these patients. It is, however, an expensive, time consuming, unpleasant and potentially harmful procedure.Recently, in patients infected with Pneumocystis carinii and Mycobacteria [6±8], sputum induction during hypertonic saline inhalation was proven to provide information comparable to that obtained by bronchoscopy and BAL. Similarly, cytological evaluation of induced sputum is considered helpful in patients with asthma and lung malignancies [9±11]. Sputum induction using hypertonic saline is efficacious in >90% of adult asthmatics [12]. Although the drop in postsalbutamol forced expiratory volume in one second (FEV1) after inhalation was larger in asthmatics than in normals a fall exceeding 20% only occurred in 3/37 patients. Sputum induction using hypertonic saline is also efficacious and safe in adolescent asthmatics [13,14] and isotonic saline sputum induction appears to be safe in children with acute asthma [15]. Although the feasibility of sputum induction has been reported in patients with CF [16], a systemati...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 65%

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Sputum induction in young cystic fibrosis patients

Boeck¹,

Alifier²,

Vandeputte³

2000

Eur Respir J

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“…In non-expectorating patients oropharyngeal cultures yielding P. aeruginosa are highly predictive [25]. However, false-negative results from throat cultures may occur making additional diagnostic tools necessary.…”

Section: Diagnosis Of Pseudomonas Aeruginosa Lung Infectionmentioning

confidence: 99%

“…Alternatively a new approach of using preservative free tobramycin in a month on/month off fashion has been shown to be superior in terms of lung function than standard care in the USA (which included intravenous treatment on demand during exacerbations) [33]. Regardless of whether or not the patients experienced exacerbations for which they received intravenous antipseudomonal antibiotics, the FEV1 predicted of patients receiving placebo, decreased steadily during the pivotal trials [25]. The benefits to lung function observed following initiation of preservative free tobramycin therapy were similar among patients with and without symptoms requiring treatment with intravenous antipseudomonal antibiotics.…”

Section: Antibiotic Strategies Against Pseudomonas Aeruginosamentioning

confidence: 99%

Antibiotic therapy against Pseudomonas aeruginosa in cystic fibrosis: a European consensus

Döring¹,

Conway²,

Heijerman³

et al. 2000

Eur Respir J

557

478

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Cystic fibrosis (CF) is the most common lethal hereditary disorder with autosomal recessive heredity in caucasians. The majority of CF patients suffer from chronic respiratory infection with the opportunistic bacterial pathogen Pseudomonas aeruginosa. No consensus among clinicians has been reached so far concerning antibiotic treatment against P. aeruginosa in CF patients.Consensus answers to 24 important questions in this context, based on current evidence, are presented, given by a panel of 34 European experts. Questions addressed and answered are: The diagnosis of P. aeruginosa lung colonization in CF; The impact of P. aeruginosa on the clinical state of CF patients; The assessment of P. aeruginosa susceptibility against antibiotics and the importance of these results for the clinician; The use of monotherapy versus combination therapy; The development of microbial resistance; The achievement of optimal airway concentrations; The effects of subinhibitory concentrations of antibiotics on P. aeruginosa; Statements on the pharmacokinetics of antibiotics in CF patients; Recommendations for doses and dosing intervals and length of treatment regimens; and Toxic side effects due to repeated antibiotic therapy was addressed.The expert panel answered further questions on the use of fluoroquinolones in children with CF, on the administration of nebulized antibiotics and whether prevention of P. aeruginosa lung colonization is possible in CF using antibiotic therapy.Problems of antibiotic therapy at home and in the hospital were addressed, a consensus statement on regular maintenance treatment, or treatment on demand, was given and different routes of administration of antibiotics were recommended for different clinical situations.Finally, the factors which determine the choice of the antibiotic, the dosage, and the duration of the treatment in cystic fibrosis patients were addressed and the design of future antibiotic studies in the context of Pseudomonas aeruginosa lung infection in cystic fibrosis patients were recommended. Eur Respir J 2000; 16: 749±767.

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