Abstract
BackgroundAcute lower respiratory infection (ALRI) is a major cause of hospitalization for children in China, while the etiological diagnosis of ALRI remains a challenge. This study was performed to evaluate the utility of the blind Nasotracheal aspiration (NTA) in the pathogen detection in ALRI through an evaluation of the test's specificity.Methodology/Principal FindingsA hospital-based study of children ≤3 years was carried out from March 2006 through March 2007 in Suzhou University Affiliated Children's Hospital, including 379 cases with ALRI from the respiratory wards, and 394 controls receiving elective surgery. Nasopharyngeal swabs (NPS) and NTA specimens were taken on admission. S. pneumoniae was isolated from 10.3% of NTA samples from ALRI children, H. influenzae from 15.3%, and M. catarrhalis from 4.7%. The false positive rate—the strains from NTA in control group children—was 8.4% (95% CI: 5.8%–11.4%) for S. pneumoniae, 27.2% (95% CI: 22.7–31.5%) for H. influenzae, and 22.1% (95% CI: 18.0%–26.2%) for M. catarrhalis. The agreement between NPS and NTA in the control group was over 70%.Conclusion/SignificanceThe blind NTA test is not a useful test for etiologic diagnosis of ALRI.
Highlights
Acute lower respiratory infection (ALRI) is a major cause of hospitalization for children in China
The lack of rapid and sensitive diagnostic tools and high morbidity associated with ALRI, and emerging antibiotic resistance strains such as S. pneumoniae and H. influenzae all support the need to improve the pathogen identification of ALRI [4,10]
Antibiotics had been administered to 86% of ALRI children within one week before admission; 80% had received one or more b-lactams, and 22% had received macrolides
Summary
Acute lower respiratory infection (ALRI) is a major cause of hospitalization for children in China. In this study we evaluated the blind Nasotracheal aspiration (NTA) test, which is frequently used as a routine diagnostic or research tool for children with pneumonia in China and in other countries in Asia [11,12,13,14,15,16,17,18]. We compared this NTA test with Nasopharyngeal swab (NPS) in children ,3 years without ALRI to examine whether the NTA test could correctly yield a negative result in children who did not have pneumonia – i.e. to evaluate the specificity of the test. Information was collected on children with a diagnosis of ALRI in case the specificity of the test warranted its use to evaluate the epidemiology of ALRI in this setting
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