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Identification of new bacterial and fungal pathogens on surveillance bronchoscopy prior to sinus surgery in patients with cystic fibrosis
Author(s) -
Kirkby Stephen,
Hayes Don,
GinnPease Margaret,
Gatz John,
Wisely Clayton Ellis,
Lind Meredith,
Elmaraghy Charles,
RyanWenger Nancy,
Sheikh Shahid I.
Publication year - 2015
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.23027
Subject(s) - medicine , sputum , bronchoalveolar lavage , functional endoscopic sinus surgery , sputum culture , bronchoscopy , cystic fibrosis , microbiological culture , respiratory tract , respiratory tract infections , antibiotics , gastroenterology , surgery , lung , respiratory system , pathology , microbiology and biotechnology , sinusitis , tuberculosis , bacteria , biology , genetics
Summary Background Flexible fiberoptic bronchoscopy was performed prior to functional endoscopic sinus surgery (FESS) while under general anesthesia to collect bronchoalveolar lavage fluid (BALF) for lower respiratory tract cultures in patients with cystic fibrosis (CF). Methods A retrospective chart review was performed on all CF patients who underwent combined FESS and bronchoscopy between January 2009 and October 2010. Along with demographic data, bacterial, fungal, and acid fast bacillus culture data from BALF was collected and compared to oropharyngeal swab and sputum cultures obtained over the year prior to FESS and bronchoscopy. Results A total of 77 patients were enrolled with mean age 12.5 ± SD 6.5 (range 2–29) years. Mean FEV 1 was 86% ± 18.4 (range 33–128) % of predicted. Patients averaged 6.5 (range 1–13) sputum or OP cultures in the year prior to FESS. BALF cultures identified a new bacterial pathogen in 19% (n = 15) of patients, which altered antibiotic regimen immediately in two patients and sub‐acutely in five patients. BALF cultures identified a new fungal pathogen in 42% (n = 32) of patients, which resulted in the addition of antifungal therapy in eight patients. BALF cultures did not identify previously undetected AFB culture positive patients. No significant differences were found between patients with and without new discoveries of bacterial or fungal pathogens with regards to key clinical demographic data, lung function parameters, healthcare utilization, or need for antibiotics over the year prior to FESS. There was no relationship between the total number of respiratory cultures obtained in the year prior to bronchoscopy and the identification of new bacterial or fungal pathogens. Conclusions Surveillance BALF cultures obtained prior to FESS identified bacterial and fungal pathogens not previously detected by sputum or OP swab cultures in a cohort of CF patients with chronic sinus disease. Moreover, the identification of these new pathogens altered clinical management in a small number of patients. Pediatr Pulmonol. 2015; 50:137–143. © 2014 Wiley Periodicals, Inc.