CF Tool No Better For Tiny Tots

Children with cystic fibrosis need pseudomonas aeruginosa test

(RxWiki News) Infants with cystic fibrosis (CF) are fragile and require a very high standard of care. Early detection of lung infections is critical to these delicate patients.

Researchers in Australia completed a study comparing the methods for diagnosing lung infections in young children with CF. The standard, less invasive throat and mouth culture was just as effective in determining infection when compared to the more invasive bronchoalveolar lavage (BAL).

"Throat and mouth cultures accurately detect infection in CF."

When children with cystic fibrosis are infected with Pseudomonas aeruginosa, diagnosing this infection can be difficult when a child is unable to produce the required mucous/saliva specimen.

For these cases, BAL, a procedure that passes a bronchoscope into the lungs to extract fluid for diagnosis is effective, but its use in a clinical setting is questionable due to operative risk.

Lead research Claire E. Wainwright, M.B.B.S., M.D., of the Royal Children's Hospital, University of Queensland, Brisbane, Australia reports that BAL-directed therapy provided no radiographic, clinical or microbiologic advantage and was riskier than the currently used diagnostic method due to adverse events caused by the bronchoscope, exposure to anesthesia and perioperative anxiety. 

Dr. Wainwright recommends the continued use of BAL as a research tool and for use in young children who aren't able to produce mucous/saliva samples. She further recommends that in clinical practice, BAL's should be limited to two scenarios:

  • Children whose conditions are rapidly deteriorating even when on antibiotics 
  • When antibiotic-resistant pathogens, including clonal P. aeruginosa strains, are possibly present.

This study included 170 infants diagnosed with cystic fibrosis through newborn screening programs in eight cystic fibrosis centers. Participants received BAL-directed (n = 84) or standard (n = 86) therapy until age 5.

The BAL-directed therapy group underwent BAL several times during this study: Before age 6 months during a healthy period, when hospitalized for pulmonary exacerbations, if P. aeruginosa was detected in the fluid specimens retrieved, they received and P. aeruginosa eradication therapy.

Treatment was prescribed according to BAL culture results. Primary outcomes at age 5 years were prevalence of P. aeruginosa on BAL cultures in both the BAL-directed and standard therapy groups and total cystic fibrosis computed tomography.

No statistically significant different outcomes were found. P. aeruginosa infection diagnosed by the BAL-directed therapy group was detected in 10 percent of the patients compared to 12 percent in the standard therapy group.

Review Date: 
July 11, 2011