Protracted bacterial bronchitis: bronchial aspirate versus bronchoalveolar lavage findings: a single-centre retrospective study

Abstract

Retrospective chart review of 133 children who underwent bronchoscopy because of possible protracted bacterial bronchitis to compare the results of bronchial aspirates with those of bronchoalveolar lavage (BAL). When comparing BAL and bronchial aspirate in 70 patients where both samples were available, the result was comparable in 46 cases (65%). If only bronchial aspirates would have been available, seven patients (10%) would have been overtreated, four children (6%) undertreated and three (4%) would have received a different treatment. Although, BAL and bronchial aspirate are comparable in the majority of cases, differences exist with an impact on treatment decision, underlying the uncertainties in the pathophysiology of protracted bacterial bronchitis.

Update on protracted bacterial bronchitis in children

“…Young children usually couldn't expectorate efficient sputum for culture and the effect of antibiotic therapy before enrollment may also contribute to the negative culture. A study reported that the culture results of bronchial aspirates were the same with BALF in some of the cases [22]. Therefore, bronchial aspirates may replace BALF in patients who couldn't tolerate a lavage or expectorate sufficient sputum for reliable culture.…”

When the Cough Does Not Improve: A Review on Protracted Bacterial Bronchitis in Children

“…Differences affecting the choice of treatment were found just in a small number of subjects with PBB (10% overtreated, 6% undertreated, 4% would have received a different therapy). The study concludes that BAL still remains the gold standard, even though BA could be considered in cases where BAL is not tolerated, considering that the results are overlapping in the majority of cases ( 19 ).…”

“…In infants, it is often easier to perform BAL in the right lower lobe being, along with lingula, the preferred site because these areas offer better fluid recovery ( 17 , 18 ). BAL is generally not well-tolerated, and although it is a safe procedure, it may cause hypoxemia; therefore, a recent study compared BAL and bronchial aspirate (BA) to investigate if the latter would bring to similar results ( 19 ). Both BAL and BA cultures provided the same result among the majority of patients (66%).…”

High levels of inherent variability in microbiological assessment of bronchoalveolar lavage samples from children with persistent bacterial bronchitis and healthy controls

“…This is consistent with the concept that quantitative cut‐offs are inappropriate in the context of chronic airways infection. Typically, “no growth” is reported for 25%–40% of BAL samples from symptomatic subjects in most PBB pediatric studies 18,20,27–30 . The current study suggests that the vagaries of sampling and conventional microbiology in the context of a chronic endobronchial biofilm infection may contribute to this high level of negative results, which is likely to be exacerbated if artificial cut‐off values are used.…”

“…Typically, "no growth" is reported for 25%-40% of BAL samples from symptomatic subjects in most PBB pediatric studies. 18,20,[27][28][29][30] The current study suggests that the vagaries of sampling and conventional microbiology in the context of a chronic endobronchial biofilm infection may contribute to this high level of negative results, which is likely to be exacerbated if artificial cut-off values are used. Current approaches may also overlook probable pathogens dismissed as contaminating "oral commensals," such as certain Neisseria species likely to be pathogenic as demonstrated in a recent microbiome study.…”