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A3690 - The Microbiology of Bronchopulmonary Infections in Clinically Stable Patients Undergoing Bronchoalveolar Lavage in Aerodigestive Population: No Viral Colonization but Many Cases of Bacterial Colonizations
Author Block: C. Conard1, K. Boyne1, R. Sabe1, J. Shah1, G. Kithcart1, B. M. Gaston2; 1Rainbow Babies and Children's Hospital, University Hospitals Medical Center, Cleveland, OH, United States, 2School of Medicine, Case Western Reserve, Cleveland, OH, United States.
Introduction: Children seen in the Aerodigestive clinic have disorders affecting their airway and/or gastrointestinal tract. As part of a comprehensive aerodigestive evaluation, they frequently undergo flexible bronchoscopy with bronchoalveolar lavage (BAL). It is not entirely clear which patients would benefit from having a BAL. Our patients frequently had bacterial or fungal cultures that were positive and responded to antimicrobial treatment. We hypothesized that specific clinical features would predict positive BAL cultures.
Methods: This is a retrospective study of children seen in the Aerodigestive clinic who had a BAL via laryngeal mask airway (LMA), to exclude oral flora, between September 2016 and September 2017. Patients with tracheostomies were excluded. All subjects had viral, bacteria, fungal and AFB cultures obtained along with cell counts and cytology (lipid laden and iron-laden macrophages indices). Data were entered into our Aerodigestive database. Diagnoses, based on ICD-10 codes, as well as bronchoscopic findings were compared between patients with and without positive cultures using Fischer’s exact test.
Results: Of 98 patients seen in the Aerodigestive clinic, during the study period, 38 underwent bronchoscopy with BAL (performed when the patient was clinically stable.) Five patients with tracheostomies were excluded. No cystic fibrosis patients were in the cohort. The mean age was 2.4 years. All patients had chronic or recurring cough and/or wheeze; reflux and dysphagia were the most common additional diagnoses. 12 of the 33 patients (36%) had a positive bacterial (n = 10) or fungal (n = 2) culture. None had a positive viral culture. The most common organisms isolated were non-typeable Haemophilus species and Streptococcus pneumoniae. Those with a positive culture tended to have higher percentages of neutrophils, but this was not statistically significant. There was no association between lipid or iron-laden macrophage indices and positive culture. Diagnoses of airway malacia, dysphagia, aspiration, and immunodeficiency did not increase the likelihood of a positive culture.
Conclusion: These data demonstrate that bronchopulmonary infection is common in clinically stable patients with chronic cough/wheeze in the aerodigestive population. Of note, none of these children had positive viral cultures, suggesting that lower airway viral infection- in the absence of acute symptoms- may be much less common than chronic nasal infection in the pediatric population. Our results suggest that BAL is important in the aerodigestive evaluation, to identify treatable chronic bronchopulmonary infection. Prospective studies are needed to identify which subjects with chronic cough and/or wheeze in the aerodigestive population should undergo BAL.