title: Diagnostic value of bronchoalveolar lavage in children with nonresponding community-acquired pneumonia.
abstract: Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality in hospitalized children. In CAP, causative agents are seldom identified using noninvasive diagnostic procedures. For those children not responding to empiric antibiotic therapy, it is vital to identify the causative pathogens for further management.
  
  
  
  We aimed to determine the usefulness of identifying the causative agents by bronchoalveolar lavage (BAL) in hospitalized children with nonresponding CAP. Ninety children hospitalized for CAP and treated with empiric antibiotics but having persistent fever ≥48 hours were enrolled, and their BAL data were retrospectively reviewed.
  
  
  
  Aerobic bacteria were isolated from 38 (42%) of 90 cultures, and anaerobic bacteria were isolated from eight (24%) of 33 cultures. The bacteria isolated most frequently were Streptococcus viridians (26.3%), Pseudomonas aeruginosa (23.7%), and Staphylococcus aureus (15.8%). Streptococcus pneumoniae was isolated from the BALs of only two children, and Haemophilus influenzae from none. For positive aerobic culture results, BAL results guided modifications of antibiotic regimens in 21 episodes (21 of 38, 55.3%).
  
  
  
  BAL results guided a change of antimicrobials in 55% of children with positive aerobic cultures (29% of all children in the study) and contributed to a high rate of successful therapy.
authors.affiliation: Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
authors.forename: Chih-Min
authors.initials: CM
authors.lastname: Tsai
authors.affiliation: Department of Pediatrics, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: pchest@adm.cgmh.org.tw.
authors.forename: Kin-Sun
authors.initials: KS
authors.lastname: Wong
authors.affiliation: Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
authors.forename: Wei-Ju
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
authors.forename: Kai-Sheng
authors.initials: KS
authors.lastname: Hsieh
authors.affiliation: Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
authors.forename: Pi-Lien
authors.initials: PL
authors.lastname: Hung
authors.affiliation: Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
authors.forename: Chen-Kuang
authors.initials: CK
authors.lastname: Niu
authors.affiliation: Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Kaohsiung, Taiwan. Electronic address: yuu2004taiwan@yahoo.com.tw.
authors.forename: Hong-Ren
authors.initials: HR
authors.lastname: Yu
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018893:Bronchoalveolar Lavage; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: bronchoalveolar lavage; children; community-acquired pneumonia