title: Sputum induction improves detection of pathogens in children with cystic fibrosis.
abstract: BACKGROUND
  Sputum induction is a safe, well tolerated means of obtaining lower airway secretions from children with cystic fibrosis (CF), particularly for assessment of airway inflammation but the clinical value in diagnosing outpatient infections has not been extensively studied.
  
  
  OBJECTIVE
  Investigate the success rate and microbiologic yield of induced sputum (IS) compared to oropharyngeal swabs (OP) and expectorated sputum (ES) samples in children with CF, and determine if IS culture results impact treatment.
  
  
  METHODS
  Two cohorts were included in this prospective, longitudinal comparative study. In one cohort, simultaneously collected OP, ES, and IS specimens were obtained from 17 CF children at three visits over 1 year. In the second group, sputum induction was performed in 35 CF subjects at four annual visits, and culture results were compared to their nearest respiratory culture within 4 months. Antimicrobial treatment regimens were captured retrospectively.
  
  
  RESULTS
  Sputum induction was successful in 149 of 158 (94%) visit encounters. Polymicrobial infection (combined P = 0.005) and gram negative organisms (combined P = 0.003) were detected more frequently in IS samples compared to OP, as were the individual pathogens Pseudomonas aeruginosa (combined P = 0.04) and Stenotrophomonas maltophilia (combined P = 0.05). The microbiologic yield of serial IS samples collected over 1 year was stable. IS culture results led to antibiotic changes in 6% of visit encounters. However, based on current practice 13% of visits could have resulted in treatment changes.
  
  
  CONCLUSIONS
  Sputum induction is feasible in the outpatient setting and appears to improve pathogen detection in children with CF.
authors.affiliation: Department of Pediatrics, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Jordana E
authors.initials: JE
authors.lastname: Hoppe
authors.affiliation: Department of Pediatrics, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Elinor
authors.initials: E
authors.lastname: Towler
authors.affiliation: Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado.
authors.forename: Brandie D
authors.initials: BD
authors.lastname: Wagner
authors.affiliation: Department of Pediatrics, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Accurso
authors.affiliation: Department of Pediatrics, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Sagel
authors.affiliation: Department of Pediatrics, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Edith T
authors.initials: ET
authors.lastname: Zemanick
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D003550:Cystic Fibrosis / Q000382:microbiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009960:Oropharynx / Q000382:microbiology; D013048:Specimen Handling / Q000379:methods*; D013183:Sputum / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Pseudomonas aeruginosa; airway infection; children; cystic fibrosis; sputum induction