Comparison of bacterial culture results in bronchoalveolar lavage and nasal lavage fluid in children with pulmonary infection

Abstract

In this prospective study, bronchoalveolar lavages (BAL) as well as nasal lavages (NL) were performed in 25 consecutive pediatric patients with pulmonary infections. It aimed to study the relevance of bacterial culture results from nasal lavage fluid as compared with broncho-alveolar lavage fluid in children with pulmonary infection. Purulent nasal secretions were observed in 9 out of 10 children presenting with acute unilateral pneumonia within 1–2 days and who had not been treated with antibiotics (Group 1), and in 10 out of 15 children who had been ill for about 1–3 weeks and had not improved, even though antibiotic therapy had been instituted (Group 2). Potential bacterial pathogens were isolated from the NL of almost all the patients (2425). In 6 of the 10 patients in Group 1, BAL cultures were positive; the pathogens present in BAL fluid were also found in the nose in all cases. In 8 of the 15 patients in Group 2, BAL cultures were positive; the pathogens present in BAL fluid were also found in the nose in 7 cases. The total number of bacterial isolates recovered from NL fluid was higher (n = 32) than that from the BAL fluid of the involved lung (n = 17). Ten patients with a positive NL fluid culture had negative BAL culture. This shows that nasal bacteriological findings were rather poor predictors of the actual bronchoalveolar bacteriology. It is, however, logically accepted that bacterial pathogens from the upper respiratory tract spread to the lower respiratory tract, but that not all bacteria sited in the nose will eventually infect the lung.