title: Bacterial distribution in the lungs of children with protracted bacterial bronchitis.
abstract: OBJECTIVE
  Flexible bronchoscopy with bronchoalveolar lavage (FB-BAL) is increasingly used for the microbiological confirmation of protracted bacterial bronchitis (PBB) in children with a chronic wet cough. At our centre, when performing FB-BAL for microbiological diagnosis we sample 6 lobes (including lingula) as this is known to increase the rate of culture positive procedures in children with cystic fibrosis. We investigated if this is also the case in children with PBB.
  
  
  METHODS
  We undertook a retrospective case note review of 50 children investigated for suspected PBB between May 2011 and November 2013.
  
  
  RESULTS
  The median (IQR) age at bronchoscopy was 2.9 (1.7-4.4) years and the median (IQR) duration of cough was 11 (8.0-14) months. Positive cultures were obtained from 41/50 (82%) and 16 (39%) of these patients isolated ≥2 organisms. The commonest organisms isolated were Haemophilus influenzae (25 patients), Moraxella catarrhalis (14 patients), Staphylococcus aureus (11 patients) and Streptococcus pneumoniae (8 patients). If only one lobe had been sampled (as per the European Respiratory Society guidance) 17 different organisms would have been missed in 15 patients, 8 of whom would have had no organism cultured at all. The FB-BAL culture results led to an antibiotic other than co-amoxiclav being prescribed in 17/41 (41%) patients.
  
  
  CONCLUSIONS
  Bacterial distribution in the lungs of children with PBB is heterogeneous and organisms may therefore be missed if only one lobe is sampled at FB-BAL. Positive FB-BAL results are useful in children with PBB and can influence treatment.
authors.affiliation: Academic Department of Child Health, University Hospital of North Staffordshire, Stoke on Trent, United Kingdom.
authors.forename: Ravi
authors.initials: R
authors.lastname: Narang
authors.affiliation: Academic Department of Child Health, University Hospital of North Staffordshire, Stoke on Trent, United Kingdom.
authors.forename: Kelly
authors.initials: K
authors.lastname: Bakewell
authors.affiliation: Academic Department of Child Health, University Hospital of North Staffordshire, Stoke on Trent, United Kingdom.
authors.forename: Jane
authors.initials: J
authors.lastname: Peach
authors.affiliation: Academic Department of Child Health, University Hospital of North Staffordshire, Stoke on Trent, United Kingdom.
authors.forename: Sadie
authors.initials: S
authors.lastname: Clayton
authors.affiliation: Academic Department of Child Health, University Hospital of North Staffordshire, Stoke on Trent, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Samuels
authors.affiliation: Paediatric Intensive Care, University Hospital of North Staffordshire, Stoke on Trent, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Alexander
authors.affiliation: Academic Department of Child Health, University Hospital of North Staffordshire, Stoke on Trent, United Kingdom; Institute of Science and Technology in Medicine, Keele University, Keele, United Kingdom.
authors.forename: Warren
authors.initials: W
authors.lastname: Lenney
authors.affiliation: Academic Department of Child Health, University Hospital of North Staffordshire, Stoke on Trent, United Kingdom; Institute of Science and Technology in Medicine, Keele University, Keele, United Kingdom.
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Gilchrist
mesh_terms: D001424:Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology; D001991:Bronchitis / Q000175:diagnosis* / Q000382:microbiology; D018893:Bronchoalveolar Lavage; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D001999:Bronchoscopy; D002675:Child, Preschool; D003371:Cough / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008168:Lung / Q000382:microbiology*; D008297:Male; D001936:Moraxella catarrhalis / Q000302:isolation & purification; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013296:Streptococcus pneumoniae / Q000302:isolation & purification