Are lower airway or throat cultures predictive of sinus bacteriology in cystic fibrosis?
Are lower airway or throat cultures predictive of sinus bacteriology in cystic fibrosis?
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DOI：
10.1002/ppul.20396
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发表时间：
2006-05-01
影响因子：
3.1
通讯作者：
Leigh, MW
中科院分区：
文献类型：
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作者：
Muhlebach, MS;Miller, MB;Leigh, MW
对于患有囊性纤维化（CF）的儿童鼻窦炎的抗生素选择是经验性的或基于下气道培养的，因为鼻窦培养很难获得。本研究的目的是鉴定慢性鼻窦炎CF患儿培养的主要微生物，并评估伴随的鼻窦、口咽拭子（OP）和支气管肺泡灌洗液（BALF）培养的一致性。术前进行OP和BALF培养，在临床指示的鼻窦手术中进行鼻窦培养。如果相同的有机体存在于上呼吸道和下呼吸道培养物中，则比较细菌的遗传特性。共纳入来自31例患者的45对窦- balf培养。其中24例具有匹配的OP培养。患者平均年龄9.5±4.3岁，19例患者为Delta F508纯合子。96%存在细菌性鼻窦感染，由金黄色葡萄球菌（49%）、铜绿假单胞菌（42%）和流感嗜血杆菌（22%）引起。在预测鼻窦感染时，BALF或OP培养的诊断准确性较低，尤其是在年轻时。BALF对铜绿假单胞菌感染的阳性预测值（PPV）和阴性预测值（NPV）分别为65%和67%；分别为76%和63%。OP培养的预测值相似。12例患者鼻窦和OP或BALF样本中细菌种类相同，其中83%具有遗传同一性。我们得出结论，金黄色葡萄球菌是儿童CF鼻窦炎的重要病原体，而BALF或口咽培养不能很好地预测鼻窦中存在的微生物。
The choice of antibiotics for sinusitis in children with cystic fibrosis (CF) is empirical or based on lower airway cultures, because sinus cultures are difficult to obtain. The aim of this study was to identify the main organisms cultured from CF children with chronic sinusitis, and to evaluate the concordance of concomitant sinus, oropharyngeal swab (OP), and bronchoalveolar lavage fluid (BALF) cultures. OP and BALF cultures were done preoperatively, and sinus cultures were obtained during clinically indicated sinus surgery. The genetic identity of the bacteria was compared if the same organisms were present in upper and lower airway cultures. In total, 45 paired sinus-BALF cultures from 31 patients were included. Twenty-four of these had matched OP cultures. The mean age of patients was 9.5 +/- 4.3 years, and 19 patients were Delta F508 homozygous. Bacterial sinus infection was present in 96%, caused by S. aureus (49%), P. aeruginosa (42%), and H. influenzae (22%). The diagnostic accuracy of BALF or OP cultures was low in predicting sinus infection, particularly at younger ages. Positive and negative predictive values (PPV and NPV) of BALF for P. aeruginosa infection were 65% and 67%, and for S. aureus; 76% and 63%, respectively. Predictive values for OP cultures were similar. Bacterial species were the same in sinus and OP or BALF samples of 12 patients of these bacteria 83% showed genetic identity. We conclude that S. aureus is an important pathogen in pediatric CF sinusitis, and that BALF or oropharyngeal cultures are poor predictors for organisms present in the sinuses.