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.”

[1]  R. Howe,et al.  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 , 2018, The Lancet. Respiratory medicine.

[2]  P. Vaes,et al.  Acute Pain Perception During Different Sampling Methods for Respiratory Culture in Cystic Fibrosis Patients. , 2017, Journal of pain and symptom management.

[3]  C. Werner,et al.  Primary Ciliary Dyskinesia: An Update on Clinical Aspects, Genetics, Diagnosis, and Future Treatment Strategies , 2017, Front. Pediatr..

[4]  J. Upham,et al.  Bronchiectasis in Children: Current Concepts in Immunology and Microbiology , 2017, Front. Pediatr..

[5]  E. Sanders,et al.  Concordance between upper and lower airway microbiota in infants with cystic fibrosis , 2017, European Respiratory Journal.

[6]  S. Stick,et al.  Induced sputum to detect lung pathogens in young children with cystic fibrosis , 2017, Pediatric pulmonology.

[7]  H. Zar,et al.  Microbiological yield from induced sputum compared to oropharyngeal swab in young children with cystic fibrosis. , 2016, Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society.

[8]  K. Mallitt,et al.  Diagnostic accuracy and distress associated with oropharyngeal suction in cystic fibrosis. , 2016, Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society.

[9]  M. Rosenfeld,et al.  Clinical Practice Guidelines From the Cystic Fibrosis Foundation for Preschoolers With Cystic Fibrosis , 2016, Pediatrics.

[10]  S. Dell,et al.  Treatment recommendations in Primary Ciliary Dyskinesia. , 2016, Paediatric respiratory reviews.

[11]  F. Accurso,et al.  Sputum induction improves detection of pathogens in children with cystic fibrosis , 2015, Pediatric pulmonology.

[12]  J. Harris,et al.  Assessment of airway microbiota and inflammation in cystic fibrosis using multiple sampling methods. , 2015, Annals of the American Thoracic Society.

[13]  Lars Kaderali,et al.  Comparison of Microbiomes from Different Niches of Upper and Lower Airways in Children and Adolescents with Cystic Fibrosis , 2015, PloS one.

[14]  Sarah Jane Schwarzenberg,et al.  European Cystic Fibrosis Society Standards of Care: Best Practice guidelines. , 2014, Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society.

[15]  B. Lamy,et al.  Advances toward the Elucidation of Hypertonic Saline Effects on Pseudomonas aeruginosa from Cystic Fibrosis Patients , 2014, PloS one.

[16]  H. Blau,et al.  Induced sputum compared to bronchoalveolar lavage in young, non-expectorating cystic fibrosis children. , 2014, Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society.

[17]  J. Sousa,et al.  Pseudomonas aeruginosa infection in cystic fibrosis lung disease and new perspectives of treatment: a review , 2013, European Journal of Clinical Microbiology & Infectious Diseases.

[18]  J. Clancy,et al.  Personalized medicine in cystic fibrosis: dawning of a new era. , 2012, American journal of respiratory and critical care medicine.

[19]  E. Kerem,et al.  Managing cystic fibrosis: strategies that increase life expectancy and improve quality of life. , 2011, American journal of respiratory and critical care medicine.

[20]  Y. Yau,et al.  Sputum induction in routine clinical care of children with cystic fibrosis. , 2010, The Journal of pediatrics.

[21]  W. Lenney,et al.  Bronchoalveolar lavage in children with cystic fibrosis: how many lobes should be sampled? , 2010, Archives of Disease in Childhood.

[22]  L. Garcia.  Respiratory Tract Cultures , 2010 .

[23]  P. Sly,et al.  Disease surveillance using bronchoalveolar lavage. , 2008, Paediatric respiratory reviews.

[24]  A. Mathai,et al.  Understanding and using sensitivity, specificity and predictive values , 2008, Indian journal of ophthalmology.

[25]  M. Corey,et al.  Comparison of throat swabs and nasopharyngeal suction specimens in non‐sputum‐producing patients with cystic fibrosis , 2006, Pediatric pulmonology.

[26]  S. Aaron,et al.  Sputum versus bronchoscopy for diagnosis of Pseudomonas aeruginosa biofilms in cystic fibrosis , 2004, European Respiratory Journal.

[27]  K. Brownlee,et al.  Clinical value of obtaining sputum and cough swab samples following inhaled hypertonic saline in children with cystic fibrosis , 2004, Pediatric pulmonology.

[28]  J. Gray.  The Dawning of a New Era , 2004 .

[29]  R. Lodha,et al.  Can throat swab after physiotherapy replace sputum for identification of microbial pathogens in children with cystic fibrosis? , 2004, Indian journal of pediatrics.

[30]  U. Wahn,et al.  Sequential genotyping of Pseudomonas aeruginosa from upper and lower airways of cystic fibrosis patients , 2002, European Respiratory Journal.

[31]  J. Emerson,et al.  Pseudomonas aeruginosa and other predictors of mortality and morbidity in young children with cystic fibrosis , 2002, Pediatric pulmonology.

[32]  A. Bush,et al.  Use of cough swabs in a cystic fibrosis clinic , 2001, Archives of disease in childhood.

[33]  J. Burns,et al.  Sputum induction as a research tool for sampling the airways of subjects with cystic fibrosis , 2001, Thorax.

[34]  J. Emerson,et al.  Longitudinal assessment of Pseudomonas aeruginosa in young children with cystic fibrosis. , 2001, The Journal of infectious diseases.

[35]  G. Connett.  Bronchoalveolar lavage. , 2000, Paediatric respiratory reviews.

[36]  J. Emerson,et al.  Diagnostic accuracy of oropharyngeal cultures in infants and young children with cystic fibrosis , 1999, Pediatric pulmonology.

[37]  J Wilson,et al.  Best Practice Guidelines , 2020, Restorative Justice for Survivors of Sexual Abuse.

[38]  J. Carlin,et al.  Bronchoalveolar lavage or oropharyngeal cultures to identify lower respiratory pathogens in infants with cystic fibrosis , 1996, Pediatric pulmonology.

[39]  R. Gibson,et al.  Predictive value of oropharyngeal cultures for identifying lower airway bacteria in cystic fibrosis patients. , 1991, The American review of respiratory disease.

[40]  R. C. Macridis.  A review , 1963 .