Cough Swab Research Articles

Bronchoscopy-guided antimicrobial therapy for cystic fibrosis.

Bronchoscopy-guided antimicrobial therapy for cystic fibrosis.

Increased antimicrobial resistance in bacterial pneumonia among Egyptian Children during the COVID-19 pandemic

BackgroundPneumonia is the major cause of morbidity and mortality among children worldwide. During the COVID-19 pandemic, the use of antibiotics increased which led to the development of antibiotic-resistant strains of pathogenic organisms causing pneumonia in children. So, studies should be directed to register antimicrobial resistance in each country and to develop local antimicrobial stewardship. This study aimed to identify the distribution of bacteria causing pneumonia among Egyptian children in the year 2020 and their antimicrobial sensitivity. A cross-sectional study was done, it included fifty immunocompetent children with pneumonia admitted to Children's Hospital, Ain-Shams University from June 2020 to December 2020. Bacterial cultures were done on sputum collected using cough swab, or endotracheal tube aspirate, with their antimicrobial sensitivity.ResultsThirty children had Community-acquired pneumonia (CAP), while twenty had Hospital-acquired pneumonia (HAP). Streptococcus pneumonia was the most frequently cultured organism in CAP group 7/30 (23.3%). The sensitivity results found linezolid (50%), followed by fluoroquinolones to be the least resistant. While in the HAP group, Klebsiella pneumonia 9/20 (45%) was the most common organism. Colistin (90%) followed by tigecycline (50%), Amikacin (35%), fluoroquinolones (25%), gentamicin (25%), and imipenem (20%) had the least resistance in the HAP group.ConclusionNo pathognomonic shift of the bacteria that causes pediatric pneumonia was detected. Although, an increase in antimicrobial resistance was noticed.

Protocol for CLASSIC PBB: comparison of lower airway sampling strategies in children with protracted bacterial bronchitis

BackgroundProtracted bacterial bronchitis (PBB) is an endobronchial infection and a the most common cause of chronic wet cough in young children. It is treated with antibiotics, which can only be...

Non-invasive diagnostics of pathogenic bacteria using a breath sampler in children with cystic fibrosis

Cystic fibrosis (CF) is a common autosomal recessive disease causing thick, viscous secretions leading to pulmonary infections with pathogenic bacteria. As part of routine patient care, colonization and infection with these bacteria is monitored with cough swab or sputum cultures and sometimes bronchoalveolar lavage. In this cross-sectional proof-of-concept study in a cohort of CF patients we collected swabs or sputa and exhaled breath samples with the modular breath sampler (MBS), a newly developed two-way non-rebreathing sampling device. Pathogen specific polymerase chain reactions (PCRs) were performed on the MBS samples and compared with the results obtained with conventional diagnostics (i.e. culturing of swabs and sputa). A control group of stable asthma patients was used as negative control for the MBS measurements. The pathogens detected using MBS and conventional culturing differed: S. aureus was found more often in swab or sputum samples whereas Pseudomonas aeruginosa and S. pneumoniae were found more often in MBS samples. We hypothesize that this is due to sampling of different compartments, MBS samples are derived from the lower respiratory tract while cultures from cough swabs and sputa are dominated by pathogens residing in the upper respiratory tract. Another important difference is the readout, i.e. culture versus PCR. The majority of CF patients in whom P. aeruginosa was found did not have recent positive cultures suggesting higher sensitivity of MBS-based than conventional diagnostics. The majority of parents/patients found the MBS easy to use and less of a burden than respiratory sampling.

P193 Audit of cough swab sampling techniques in children with cystic fibrosis

P193 Audit of cough swab sampling techniques in children with cystic fibrosis

P181 A pilot service evaluation to determine the benefit of a cough swab following inhaled hypertonic saline in patients with cystic fibrosis under 4 years old

P181 A pilot service evaluation to determine the benefit of a cough swab following inhaled hypertonic saline in patients with cystic fibrosis under 4 years old

P172 Simultaneous collection of cough plate and cough swab samples increases the detection of respiratory pathogens in non-expectorating children with cystic fibrosis

P172 Simultaneous collection of cough plate and cough swab samples increases the detection of respiratory pathogens in non-expectorating children with cystic fibrosis

Pathophysiological Mechanisms of Asthma.

The recent Lancet commission has highlighted that “asthma” should be used to describe a clinical syndrome of wheeze, breathlessness, chest tightness, and sometimes cough. The next step is to deconstruct the airway into components of fixed and variable airflow obstruction, inflammation, infection and altered cough reflex, setting the airway disease in the context of extra-pulmonary co-morbidities and social and environmental factors. The emphasis is always on delineating treatable traits, including variable airflow obstruction caused by airway smooth muscle constriction (treated with short- and long-acting β-2 agonists), eosinophilic airway inflammation (treated with inhaled corticosteroids) and chronic bacterial infection (treated with antibiotics with benefit if it is driving the disease). It is also important not to over-treat the untreatable, such as fixed airflow obstruction. These can all be determined using simple, non-invasive tests such as spirometry before and after acute administration of a bronchodilator (reversible airflow obstruction); peripheral blood eosinophil count, induced sputum, exhaled nitric oxide (airway eosinophilia); and sputum or cough swab culture (bacterial infection). Additionally, the pathophysiology of risk domains must be considered: these are risk of an asthma attack, risk of poor airway growth, and in pre-school children, risk of progression to eosinophilic school age asthma. Phenotyping the airway will allow more precise diagnosis and targeted treatment, but it is important to move to endotypes, especially in the era of increasing numbers of biologicals. Advances in -omics technology allow delineation of pathways, which will be particularly important in TH2 low eosinophilic asthma, and also pauci-inflammatory disease. It is very important to appreciate the difficulties of cluster analysis; a patient may have eosinophilic airway disease because of a steroid resistant endotype, because of non-adherence to basic treatment, and a surge in environmental allergen burden. Sophisticated –omics approaches will be reviewed in this manuscript, but currently they are not being used in clinical practice. However, even while they are being evaluated, management of the asthmas can and should be improved by considering the pathophysiologies of the different airway diseases lumped under that umbrella term, using simple, non-invasive tests which are readily available, and treating accordingly.

Investigating evolution of the paediatric cystic fibrosis lung microbiota using induced sputum sampling and culture-independent techniques

Background Children with cystic fibrosis are frequently non-productive of sputum even during exacerbation. Current routine sampling methods are either invasive (Bronchoalveolar lavage; BAL) or insensitive (cough swab) which makes pathogen surveillance challenging. We investigated induced sputum (IS) as a promising complementary sampling technique, looking at both its comparison to BAL and the evolution of the lung microbiota across children aged 0.5–18 years. Methods BAL and IS samples were collected as part of the CF-SpIT study (UKCRN14615; ISRCTNR12473810). DNA was extracted from samples and Illumina NextSeq sequencing of the 16S rRNA gene V4 region was performed. Bioinformatics data processing was carried out using Mothur. Microsoft Excel and R statistical software were used for downstream analyses. Results Comparison of the microbiota of 30 BAL-IS matched patient samples indicated that at a presence/absence level, IS captured >80 % of the pathogens observed in BAL samples. These findings validated the expansion of the study to 136 un-matched IS sputum samples, and we found that as patient age increased, bacterial diversity decreased, and changes in the abundance of key genera occurred over time. Both Neisseria and Haemophilus decreased with age, whilst Pseudomonas and a sub-group of Prevotella increased. Conclusions Here we uniquely demonstrate using culture-independent techniques that IS captures the majority of the bacterial diversity observed in BAL samples. The age associated decline in lung microbiota diversity, previously documented using BAL samples, can also be captured using IS samples. This suggests that surveillance of microbiota evolution may be possible using this method.

Secretory IgA-mediated immune response in saliva and early detection of Pseudomonas aeruginosa in the lower airways of pediatric cystic fibrosis patients.

Pseudomonas aeruginosa (Pa) detection in the paranasal sinuses may help to prevent or postpone bacterial aspiration to the lower airways (LAW) and chronic lung infection in cystic fibrosis (CF). We assessed the ability of an ELISA test for measurement of specific Pa secretory IgA (sIgA) in saliva (a potential marker of sinus colonization) to early detect changes in the Pa LAW status (indicated by microbiological sputum or cough swab culture and specific serum IgG levels) of 65 patients for threeyears, in different investigation scenarios. Increased sIgA levels were detected in saliva up to 22months before changes in culture/serology. Patients who remained Pa-positive had significantly increased sIgA levels than patients who remained Pa-negative, both at the baseline (39.6 U/mL vs. 19.2 U/mL; p = 0.02) and at the end of the follow-up (119.4 U/mL vs. 25.2 U/mL; p < 0.001). No association was found between sIgA levels in saliva and emergence or recurrence of Pa in the LAW. A positive median sIgA result in the first year of follow-up implied up to 12.5-fold increased risk of subsequent Pa exposure in the LAW. Our test detected early changes in the P. aeruginosa LAW status and risk of exposure to P. aeruginosa in the LAW with twoyears in advance. Comparison with sinus culture is needed to assess the test's ability to identify CF patients in need of a sinus approach for Pa investigation, which could provide opportunities of Pa eradication before its aspiration to the lungs.

Respiratory Bacterial Culture Sampling in Expectorating and Non-expectorating Patients With Cystic Fibrosis

Purpose: Different respiratory sampling methods exist to identify lower airway pathogens in patients with cystic fibrosis (CF), of which bronchoalveolar lavage (BAL), and expectorated sputum are considered the “gold standard.” Because BAL cannot be repeated limitless, the diagnosis of lower respiratory tract infections in non-expectorating patients is challenging. Other sampling techniques are nasal swab, cough swab, and induced sputum. The purpose of this study (NCT02363764) was to compare concordance between the microbiological yield of nasal swab, cough swab, and expectorated sputum in expectorating patients; nasal swab, cough swab, and induced sputum in non-expectorating patients; nasal swab, cough swab, induced sputum, and BAL in patients requiring bronchoscopy (“BAL-group”); and to determine the clinical value of cough swab in non-expectorating patients with CF.Methods: Microbiological yield detected by these different sampling techniques was compared between and within 105 expectorating patients, 30 non-expectorating patients and BAL-group (n = 39) in a single CF clinic. Specificity, sensitivity, positive (PPV), and negative (NPV) predictive values were calculated.Results: Overall low sensitivity (6.3–58.0%) and wide-ranging predictive values (0.0–100.0%) indicated that nasal swab was not appropriate to detect lower airway pathogens [Pseudomonas aeruginosa (Pa), Staphylococcus aureus (Sa), and Haemophilus influenzae (Hi)] in all three patient groups. Microbiological yield, specificity, sensitivity, PPV, and NPV of cough swab and induced sputum were largely similar in non-expectorating patients and in BAL-group (except sensitivity (0.0%) of induced sputum for Hi in BAL-group). Calculations for Pa and Hi could not be performed for non-expectorating patients because of low prevalence (n = 2 and n = 3, respectively). In expectorating patients, concordance was found between cough swab and expectorated sputum, except for Hi (sensitivity of 40.0%).Conclusion: Our findings suggest that cough swab might be helpful in detecting the presence of some typical CF pathogens in the lower airways of clinically stable patients with CF. However, in symptomatic patients, who are unable to expectorate and who have a negative cough swab and induced sample, BAL should be performed as it currently remains the “gold standard.”

Bronchoscopy-guided antimicrobial therapy for cystic fibrosis.

Early diagnosis and treatment of lower respiratory tract infections are the mainstay of management of lung disease in cystic fibrosis. When sputum samples are unavailable, treatment relies mainly on cultures from oropharyngeal specimens; however, there are concerns regarding the sensitivity of these to identify lower respiratory organisms.Bronchoscopy and related procedures (including bronchoalveolar lavage) though invasive, allow the collection of lower respiratory specimens from non-sputum producers. Cultures of bronchoscopic specimens provide a higher yield of organisms compared to those from oropharyngeal specimens. Regular use of bronchoscopy and related procedures may help in a more accurate diagnosis of lower respiratory tract infections and guide the selection of antimicrobials, which may lead to clinical benefits.This is an update of a previous review. To evaluate the use of bronchoscopy-guided antimicrobial therapy in the management of lung infection in adults and children with cystic fibrosis. We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of latest search: 30 August 2018.We also searched three registries of ongoing studies and the reference lists of relevant articles and reviews. Date of latest search: 10 April 2018. We included randomized controlled studies including people of any age with cystic fibrosis, comparing outcomes following therapies guided by the results of bronchoscopy (and related procedures) with outcomes following therapies guided by the results of any other type of sampling (including cultures from sputum, throat swab and cough swab). Two review authors independently selected studies, assessed their risk of bias and extracted data. We contacted study investigators for further information. The quality of the evidence was assessed using the GRADE criteria. The search identified 11 studies, but we only included one study enrolling infants with cystic fibrosis under six months of age and diagnosed through newborn screening (170 enrolled); participants were followed until they were five years old (data from 157 children). The study compared outcomes following therapy directed by bronchoalveolar lavage for pulmonary exacerbations with standard treatment based on clinical features and oropharyngeal cultures.We considered this study to have a low risk of bias; however, the statistical power to detect a significant difference in the prevalence of Pseudomonas aeruginosa was limited due to the prevalence (of Pseudomonas aeruginosa isolation in bronchoalveolar lavage samples at five years age) being much lower in both the groups compared to that which was expected and which was used for the power calculation. The sample size was adequate to detect a difference in high-resolution computed tomography scoring. The quality of evidence for the key parameters was graded as low except high-resolution computed tomography scoring and cost of care analysis, which were graded as moderate quality.At five years of age, there was no clear benefit of bronchoalveolar lavage-directed therapy on lung function z scores or nutritional parameters. Evaluation of total and component high-resolution computed tomography scores showed no significant difference in evidence of structural lung disease in the two groups.In addition, this study did not show any difference between the number of isolates of Pseudomonas aeruginosa per child per year diagnosed in the bronchoalveolar lavage-directed therapy group compared to the standard therapy group. The eradication rate following one or two courses of eradication treatment was comparable in the two groups, as were the number of pulmonary exacerbations. However, the number of hospitalizations was significantly higher in the bronchoalveolar lavage-directed therapy group, but the mean duration of hospitalizations was significantly less compared to the standard therapy group.Mild adverse events were reported in a proportion of participants, but these were generally well-tolerated. The most common adverse event reported was transient worsening of cough after 29% of procedures. Significant clinical deterioration was documented during or within 24 hours of bronchoalveolar lavage in 4.8% of procedures. This review, limited to a single, well-designed randomized controlled study, shows no clear evidence to support the routine use of bronchoalveolar lavage for the diagnosis and management of pulmonary infection in pre-school children with cystic fibrosis compared to the standard practice of providing treatment based on results of oropharyngeal culture and clinical symptoms. No evidence was available for adult and adolescent populations.

The CF-Sputum Induction Trial (CF-SpIT) to assess lower airway bacterial sampling in young children with cystic fibrosis: a prospective internally controlled interventional trial

SummaryBackgroundPathogen surveillance is challenging but crucial in children with cystic fibrosis—who are often non-productive of sputum even if actively coughing—because infection and lung disease begin early in life. The role of sputum induction as a diagnostic tool for infection has not previously been systematically addressed in young children with cystic fibrosis. We aimed to assess the pathogen yield from sputum induction compared with that from cough swab and single-lobe, two-lobe, and six-lobe bronchoalveolar lavage.MethodsThis prospective internally controlled interventional trial was done at the Children's Hospital for Wales (Cardiff, UK) in children with cystic fibrosis aged between 6 months and 18 years. Samples from cough swab, sputum induction, and single-lobe, two-lobe, and six-lobe bronchoalveolar lavage were matched for within-patient comparisons. Primary outcomes were comparative pathogen yield between sputum induction and cough swab for stage 1, and between sputum induction, and single-lobe, two-lobe, and six-lobe bronchoalveolar lavage for stage 2. Data were analysed as per protocol. This study is registered with the UK Clinical Research Network (14615) and with the International Standard Randomised Controlled Trial Network Registry (12473810).FindingsBetween Jan 23, 2012, and July 4, 2017, 124 patients were prospectively recruited to the trial and had 200 sputum induction procedures for stage 1. 167 (84%) procedures were successful and the procedure was well tolerated. Of the 167 paired samples, 63 (38%) sputum-induction samples were pathogen positive compared with 24 (14%) cough swabs (p<0·0001; odds ratio [OR] 7·5; 95% CI 3·19–17·98). More pathogens were isolated from sputum induction than cough swab (79 [92%] of 86 vs 27 [31%] of 86; p<0·0001). For stage 2, 35 patients had a total of 41 paired sputum-induction and bronchoalveolar lavage procedures. Of the 41 paired samples, 28 (68%) were positive for at least one of the concurrent samples. 39 pathogens were isolated. Sputum induction identified 27 (69%) of the 39 pathogens, compared with 22 (56%; p=0·092; OR 3·3, 95% CI 0·91–12·11) on single-lobe, 28 (72%; p=1·0; OR 1·1, 95% CI 0·41–3·15) on two-lobe, and 33 (85%; p=0·21; OR 2·2, 95% CI 0·76–6·33) on six-lobe bronchoalveolar lavage.InterpretationSputum induction is superior to cough swab for pathogen detection, is effective at sampling the lower airway, and is a credible surrogate for bronchoalveolar lavage in symptomatic children. A substantial number of bronchoscopies could be avoided if sputum induction is done first and pathogens are appropriately treated. Both sputum induction and six-lobe bronchoalveolar lavage provide independent, sizeable gains in pathogen detection compared with the current gold-standard two-lobe bronchoalveolar lavage. We propose that sputum induction and six-lobe bronchoalveolar lavage combined are used as standard of care for comprehensive lower airway pathogen detection in children with cystic fibrosis.FundingHealth and Care Research Wales—Academic Health Science Collaboration and Wellcome Trust Institutional Strategic Support Fund.

It ain't necessarily so: a surprising lower airway infection

Rossa Brugha (Junior Doctor): A 3-year-old boy with cystic fibrosis (CF) diagnosed on newborn screening (sweat chloride 90 mmol/L, F508del homozygous) attended routine follow-up in the CF clinic. He had...

16 CF newborn screening in Uruguay: improvements in IRT methodology

diagnosis 25.8 days (range 1–63, s.d. 13.2). By end of year 1, 30% grew Pseudomonas (inc aeruginosa), 36% had abnormal chest x-rays, 27% required IV antibiotics. No correlation between number of contacts with the team and abnormal x-ray, need for intravenous antibiotics, psychosocial issues or positive respiratory (lavage & cough swab) samples in year 1. Children with pancreatic insufficiency had more contacts with the nurse in the year following diagnosis (16 contacts more, 95%CI 4.6–27.3, p = 0.007) than children who were pancreatic sufficient. Per additional week of oral antibiotics, children had 0.7 more contacts (95%CI 0.1 to 1.3, p = 0.025). When both variables were taken into account, pancreatic insufficiency and an additional week of oral antibiotics were associated with 14.5 more contacts (95%CI 3.7–25.4, p = 0.01) and 0.6 more contacts (95%CI 0.04–1.1, p = 0.04) respectively. Conclusion: Data shows more communication with parents whose children are pancreatic insufficient and need more oral antibiotics. It is unclear whether this reflects increased clinical need or parental anxiety. Screening has revolutionised CF care and we employ a policy of frequent contact & support responsive to parental needs.

Bronchoscopy-guided antimicrobial therapy for cystic fibrosis.

Early diagnosis and treatment of lower respiratory tract infections are the mainstay of management of lung disease in cystic fibrosis. When sputum samples are unavailable, treatment relies mainly on cultures from oropharyngeal specimens; however, there are concerns regarding the sensitivity of these to identify lower respiratory organisms.Bronchoscopy and related procedures (including bronchoalveolar lavage) though invasive, allow the collection of lower respiratory specimens from non-sputum producers. Cultures of bronchoscopic specimens provide a higher yield of organisms compared to those from oropharyngeal specimens. Regular use of bronchoscopy and related procedures may help in a more accurate diagnosis of lower respiratory tract infections and guide the selection of antimicrobials, which may lead to clinical benefits.This is an update of a previous review. To evaluate the use of bronchoscopy-guided antimicrobial therapy in the management of lung infection in adults and children with cystic fibrosis. We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched two registries of ongoing studies and the reference lists of relevant articles and reviews.Date of latest search: 28 August 2015. We included randomized controlled studies including people of any age with cystic fibrosis, comparing outcomes following therapies guided by the results of bronchoscopy (and related procedures) with outcomes following therapies guided by the results of any other type of sampling (including cultures from sputum, throat swab and cough swab). Two review authors independently selected studies, assessed their risk of bias and extracted data. We contacted study investigators for further information. The search identified nine studies, but only one study with data from 157 participants (170 people were enrolled) was eligible for inclusion in the review. This study compared outcomes following therapy directed by bronchoalveolar lavage for pulmonary exacerbations during the first five years of life with standard treatment based on clinical features and oropharyngeal cultures. The study enrolled infants with CF who were under six months of age and diagnosed through newborn screening and followed them until they were five years old.We considered this study to have a low risk of bias; however, the statistical power to detect a significant difference in the prevalence of Pseudomonas aeruginosa was limited due to the prevalence (of Pseudomonas aeruginosa isolation in bronchoalveolar lavage samples at five years age) being much lower in both the groups compared to that which was expected and which was used for the power calculation. The sample size was adequate to detect a difference in high-resolution computed tomography scoring. The quality of evidence for the key parameters was graded as moderate except high-resolution computed tomography scoring and cost of care analysis, which were graded as high quality.At five years of age, there was no clear benefit of bronchoalveolar lavage-directed therapy on lung function z scores or nutritional parameters. Evaluation of total and component high-resolution computed tomography scores showed no significant difference in evidence of structural lung disease in the two groups.In addition, this study did not show any difference between the number of isolates of Pseudomonas aeruginosa per child per year diagnosed in the bronchoalveolar lavage-directed therapy group compared to the standard therapy group. The eradication rate following one or two courses of eradication treatment was comparable in the two groups, as were the number of pulmonary exacerbations. However, the number of hospitalizations was significantly higher in the bronchoalveolar lavage-directed therapy group, but the mean duration of hospitalizations was significantly less compared to the standard therapy group.Mild adverse events were reported in a proportion of participants, but these were generally well-tolerated. The most common adverse event reported was transient worsening of cough after 29% of procedures. Significant clinical deterioration was documented during or within 24 hours of bronchoalveolar lavage in 4.8% of procedures. This review, limited to a single, well designed randomized-controlled study, shows no clear evidence to support the routine use of bronchoalveolar lavage for the diagnosis and management of pulmonary infection in pre-school children with cystic fibrosis compared to the standard practice of providing treatment based on results of oropharyngeal culture and clinical symptoms. No evidence was available for adult and adolescent populations.

69 The Cystic Fibrosis Sputum Induction Trial (CF-SpIT). Induced sputum in young healthy non-productive children with cystic fibrosis

Objective Young children with CF are often non-productive of sputum even during a chest exacerbation. Effective bacterial surveillance is challenging, but critical as respiratory infection and lung disease begins early in life. CF-SpIT (CF-Sputum Induction Trial: UKCRN 14615) seeks to identify whether using induced sputum (IS) improves bacterial surveillance, in young non-productive children with CF. Methods 86 children from CF-SpIT are included in this analysis. In all cases, a routine cough swab (CS) was followed by IS. Paired samples were compared for microbiology yield. In 20 children, where bronchoscopy was clinically indicated, CS, IS and extensive 6 lobe bronchoalveolar lavage (BAL) were compared for microbiology yield. Results IS was tolerated in 98% of patients, and successful in 81% (n = 69). Tolerability and success did not differ in children below or above 6 years of age, despite more of the younger cohort being naive to hypertonic saline (30%), not spontaneously productive (92%) and unwell at the time (68%). Of the 69 patients, 17% had positive cough swabs, 47% had positive IS samples (χ 2 = 10. P=0.002). IS identified a pathogen not previously isolated in the previous year in 29% of patients. In 20 patients where CS, IS and BAL were taken, 20 pathogens were grown in 16 patients. CS, IS and BAL identified 5, 13 and 14 pathogens respectively. Pathogens were identified on IS but not on BAL in 4 patients. 16S sequencing of culture-negative BAL was positive for the pathogen identified on IS in 3 of 4 cases. Conclusion Induced Sputum is a well tolerated, non-invasive, effective way to sample the lower airway in young non-productive healthy children with CF.

76 Identification of Pseudomonas aeruginosa infection in a paediatric CF population

Objective To analyse the importance of obtaining regular sputum samples in identifying P. aeruginosa infection in a paediatric cystic fibrosis (CF) population. Royal Manchester Children's Hospital provides care to 182 children with CF. Sputum and/or cough swab samples are taken at each clinic visit. Our local practice is to encourage families to also send sputum samples/ cough swabs to us twice a month. Methods Analysis of cough swab and sputum samples of all our CF patients during a 2-year period (October 2012 to September 2014). Children were classified according to the Leeds criteria for P. aeruginosa infection, with an additional category of Results 5973 samples were obtained over the 2-year period from our CF population. Table 1P. aeruginosa statusNumber of children (total = 182)Never infected61 (33%)Free of infection67 (37%)Intermittent infection29 (16%)Chronic infection18 (10%)First growth7 (4%) We then analysed P. aeruginosa status if only samples taken at clinic were used. Table 2. Table 2P. aeruginosa statusNumber of childrenAll samplesClinic samples onlyIntermittent infection2914First growth74 If clinic samples alone were analysed, we would have identified 14/29 children with intermittent infection and 4/7 children with first growth. Conclusion Potentially significant pathogens may not be identified if sputum/cough swab samples are only obtained at clinic visits. In our CF population, 18 children (10%) with P. aeruginosa growth would not have been identified if samples had only been taken at clinic.

The efficacy of cough plates in the identification of bacterial pathogens in children with cystic fibrosis

BackgroundIdentification of bacterial pathogens is paramount for prompt and effective treatment of respiratory exacerbations in children with cystic fibrosis (CF). This can be a challenge in non-expectorating patients as reliability...

Comparison of two treatment regimens for eradication of Pseudomonas aeruginosa infection in children with cystic fibrosis

In patients with cystic fibrosis (CF), treatment of new Pseudomonas aeruginosa (Pa) infection postpones the occurrence of chronic infection, but the best eradication regimen is unknown . Aim of the studyCompare 2 Pa eradication regimens in children with new Pa infection. MethodsChildren with CF (0–18years) and a new isolation of Pa from sputum, cough swab or BAL were randomized to treatment with tobramycin inhalation solution for 28days (TIS) or inhaled sodiumcolistimethate (2×2millU/day) plus oral ciprofloxacin (30mg/kg/day) for 3months (CC). Airway cultures were taken for 6 consecutive months, then every 3months. The primary outcome was Pa eradication at the end of treatment. Secondary outcome parameters were: time to Pa relapse from end of treatment, total and Pa specific IgG, FEV1, BMI and Pa status at 2year follow-up. Results58 patients with new Pa isolation were randomized. Their median age was 9years (IQR 4.7–13.1) and their median FEV1 98% predicted (IQR 87–107). Eighteen treatments concerned the first Pa isolation ‘ever’ (TIS: 8; CC: 10). For the remaining, median time since previous Pa was 19months (IQR 9–41). Eradication at end of treatment was similar for both treatments: 26/29 CC and 23/29 in TOBI treated patients (p=0.47). Median time to recurrence of Pa was 9months (95% CI 0.0–19.0) for CC and 5months (95% CI 1.7–8.3) for TIS (p=0.608). After 1year, the 2 groups did not differ in change in total and Pa specific IgG, FEV1 and BMI. After 2years, 10% of patients had chronic Pa infection. ConclusionIn children with CF and new Pa infection, inhalation of TIS (28days) or CC (3months) resulted in similar eradication success at the end of treatment (80 and 90% respectively) and similar clinical evolution during the first 2years of follow-up.