Bronchoalveolar lavage for etiological diagnosis of childhood pneumonia

Authors

  • Gouda Ankula Kartikeswar Kartikeswar Department of Paediatrics, KEM hospital, Pune, Maharashtra, India
  • Helina Rahman Department of Paediatrics, Assam Medical College and Hospital, Dibrugarh, Assam, India
  • H. K. Dutta Department of Paediatricssurgery, Assam Medical College and Hospital, Dibrugarh, Assam, India
  • Amit Kumar satapathy Department of Paediatrics, AIIMS, Bhubaneswar, Odisha, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20192040

Keywords:

Antibiotic resistance, Bronchoalveolar lavage, Blood culture, Childhood pneumonia

Abstract

Background: Pneumonia is the most common cause of childhood morbidity and mortality in age group less than 5 years. Identification of causative organism is a real challenge in these children though many of them are responding to the first line antibiotics therapy. Isolation of the organism is of paramount importance those who fails to respond to first line therapy. The objective of this study was to determine the relative efficacy of Bronchoalveolar Lavage (BAL) over blood culture in finding out causative organisms of childhood non responder community acquired pneumonia and to study antibiotic-sensitivity pattern of causative organisms.  

Methods: BAL and blood culture was performed in 17 patients of age 2 months to 5 years with pneumonia or severe pneumonia. Lavage fluid was cultured and growth of organism 10000CFU/ml was considered positive. Blood culture was taken on the same day. Antibiotic sensitivity was tested.

Results: BAL isolated the organism in 82.35% (n=14) cases out of 17 patients and in 11.76% (n=2) by blood culture (p=0.002). Streptococcus pneumoniae was the most common organism isolated (58.82% (n=10)), followed by K. pneumoniae (23.53% (n=4)). Antibiotic therapy was changed in 58.82% (n=10) cases according on culture report. Transient rise in temperature, tachycardia and tachypnea was noted after procedure but no major complication was associated with BAL.

Conclusions: BAL fluid culture in childhood pneumonia has high diagnostic value and better efficacy over blood culture in isolating causative organism without increased risk of complication and decreases unwanted exposure to empiric antibiotic in children with community acquired pneumonia who did not respond to initial 1st line therapy.

References

Sandora TJ, Sectish TC. Community-acquired pneumonia. In: Kliegman RM, Stanton BF, Schor NF, Geme JS, Behrman RE, eds. Nelson text book of paediatrics. 19th ed. Philadelphia: Elsevier. 2012; 1421:1474-9.

Agrawal R. Pneumonia. In: Parthasarathi A, Menon PSN, Gupta P, Nair MKC eds. IAP Textbook of Pediatrics. 5th ed. New Delhi: Jaypee. 2013:470-4.

World Health Organization. The management of acute respiratory infections in children: practical guidelines for outpatient care. Available at: https://apps.who.int/iris/handle/10665/41803.

IAP recommendation for protection against, prevention of, and treatment of childhood pneumonia. Available at: http://www.fightpneumonia.org/download/guidelines/iap_recommendations_on_pneumonia.pdf.

Gauvin F, Dassa C, Chaïbou M, Proulx F, Farrell CA, Lacroix J. Ventilator-associated pneumonia in intubated children: comparison of different diagnostic methods. InCritic Care. 2003;7(2):145.

Mccracken Jr GH. Diagnosis and management of pneumonia in children. Pediatr Infect Dis J. 2000;19(9):924-8.

Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, et al. Pediatric infectious diseases society and the infectious diseases society of America. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the paediatric infectious diseases society and the infectious diseases society of America. Clin Infect Dis. 2011;53(7):e25-76.

de Blic J, McKelvie P, Le Bourgeois M, Blanche S, Benoist MR, Scheinmann P. Value of bronchoalveolar lavage in the management of severe acute pneumonia and interstitial pneumonitis in the immunocompromised child. Thorax. 1987;42(10):759-65.

De Schutter I, De Wachter E, Crokaert F, Verhaegen J, Soetens O, Piérard D, et al. Microbiology of bronchoalveolar lavage fluid in children with acute nonresponding or recurrent community-acquired pneumonia: identification of nontypeable haemophilus influenzae as a major pathogen. Clinic Infect Dis. 2011;52(12):1437-44.

Selimović A, Pejčić T, Rančić M, Mujičić E, Bajrović K. Bronchoscopy and bronchoalveolar lavage in children with lower airway infection and most common pathologic microorganisms isolated. Acta Facultatis Medicae Naissensis. 2012;29(1):17-21.

Kabra SK, Lodha R, Broor S, Chaudhary R, Ghosh M, Maitreyi RS. Etiology of acute lower respiratory tract infection. Indian J Pediatr. 2003;70(1):33-6.

Falade AG, Mulholland EK, Adegbola RA, Greenwood BM. Bacterial isolates from blood and lung aspirate cultures in Gambian children with lobar pneumonia. Ann Trop Paediatr. 1997;17(4):315-9.

Myers AL, Hall M, Williams DJ, Auger K, Tieder JS, Statile A, et al. Prevalence of bacteremia in hospitalized pediatric patients with community-acquired pneumonia. Pediatr Infect Dis J. 2013;32(7):736.

Luna CM, Videla A, Mattera J, Vay C, Famiglietti A, Vujacich P, et al. Blood cultures have limited value in predicting severity of illness and as a diagnostic tool in ventilator-associated pneumonia. Chest. 1999;116(4):1075-84.

Khattab AA, El-Lahony DM, Soliman WF. Ventilator-associated pneumonia in the neonatal intensive care unit. Menoufia Med J. 2014;27(1):73.

Devi U, Ayyagari A, Devi KR, Narain K, Patgiri DK, et al. Serotype distribution and sensitivity pattern of nasopharyngeal colonizing Streptococcus pneumoniae among rural children of eastern India. Indian J Med Res. 2012;136(3):495.

Arora NK. Rational use of antibiotics for pneumonia. Indian Pediatr. 2010;47(1):11-8.

Somu N, Vijayasekaran D, Subramanyam L, Shhankar NG, Balachandran A, Joseph MC. Flexible fiberoptic bronchoscopy. Indian J Pediatr. 1996;63(2):171-80.

Downloads

Published

2019-04-30

Issue

Section

Original Research Articles