{
  "abstract": "Background Protracted bacterial bronchitis (PBB) is a leading cause of paediatric chronic wet cough. Identifying the causative pathogen promotes antibiotic stewardship, but bronchoalveolar lavage taken during flexible bronchoscopy (FB-BAL) is the only validated sampling strategy. We prospectively investigated if cough swab (CS) or induced sputum (IS) was a viable alternative.Methods Children with PBB, referred for FB-BAL, provided a cough swab and induced sputum. Discordance in microbiological yield (failure to identify identical pathogens) between cough swab and BAL, and between induced sputum and BAL was assessed. This was performed for single-lobe (BAL1), two-lobe (BAL2) and six-lobe BAL (BAL6).Results 135 underwent FB-BAL, 134 produced a cough swab and 111 an induced sputum sample. 30 (22%) cough swab, 67 (60%) induced sputum and 101 (78%) BAL6 were pathogen positive. cough swab/BAL6 discordance was seen in 74% with a discordance OR (95% CI) for cough swab −BAL6+ versus cough swab+BAL6− of 30.3 (9.6 to 95.8). induced sputum/BAL6 discordance was seen in 71% with a discordance OR (95% CI) for induced sputum−BAL6+ versus induced sputum+BAL6− of 4.2 (2.4 to 7.4). The ability of each sampling strategy to identify all pathogens from cough swab, induced sputum and BAL6 was: cough swab 17%, induced sputum 38%, BAL1 40%, BAL2 53% and BAL6 78%. The false negative rates were: cough swab 67%, induced sputum 27%, BAL1 33%, BAL2 16% and BAL6 9%.Conclusions The pathogen yield of both cough swab and induced sputum had high discordance with BAL6, meaning neither is a viable alternative to FB-BAL. However, the tolerability and relatively low false negative rate of induced sputum mean it can be part of early PBB assessment in children who do not warrant FB-BAL.",
  "authors": [
    {
      "affiliations": [
        "Department of Paediatric Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK",
        "School of Medicine, Keele University, Newcastle-under-Lyme, UK"
      ],
      "name": "Francis J Gilchrist"
    },
    {
      "affiliations": [
        "School of Medicine, Keele University, Newcastle-under-Lyme, UK"
      ],
      "name": "Ivonne Solis-Trapala"
    },
    {
      "affiliations": [
        "Research and Innovation Directorate, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK"
      ],
      "name": "Mathew Aspey"
    },
    {
      "affiliations": [
        "Department of Paediatric Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK"
      ],
      "name": "Zoe Baker"
    },
    {
      "affiliations": [
        "Research and Innovation Directorate, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK"
      ],
      "name": "Robert Bowler"
    },
    {
      "affiliations": [
        "Department of Paediatric Respiratory Medicine, Great North Children’s Hospital, Newcastle upon Tyne, UK",
        "Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, England, UK"
      ],
      "name": "Malcolm Brodlie"
    },
    {
      "affiliations": [
        "Department of Microbiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK"
      ],
      "name": "Seema Desai"
    },
    {
      "affiliations": [
        "Department of Paediatric Respiratory Medicine, Great North Children’s Hospital, Newcastle upon Tyne, UK"
      ],
      "name": "Caroline Harris"
    },
    {
      "affiliations": [
        "On Behalf of Patient and Public Involvement and Engagement for CLASSIC PBB, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, England, UK"
      ],
      "name": "Emily Hinton"
    },
    {
      "affiliations": [
        "Department of Paediatric Respiratory Medicine, Sheffield Children’s Hospital NHS Foundation Trust, Sheffield, England, UK"
      ],
      "name": "Hemant Kulkarni"
    },
    {
      "affiliations": [
        "Research and Development, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK"
      ],
      "name": "Simon Lea"
    },
    {
      "affiliations": [
        "Research and Innovation Directorate, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK"
      ],
      "name": "Aviva Ogbolosingha"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Alder Hey Children’s NHS Foundation Trust, Liverpool, England, UK"
      ],
      "name": "Ian Sinha"
    },
    {
      "affiliations": [
        "Department of Paediatric Respiratory Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK"
      ],
      "name": "Joanne Stock"
    },
    {
      "affiliations": [
        "Academic Department of Paediatrics, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, England, UK"
      ],
      "name": "Will Carroll"
    },
    {
      "affiliations": [],
      "name": "CLASSIC PBB study group"
    }
  ],
  "title": "Comparison of Lower Airway Sampling Strategies in Children with Protracted Bacterial Bronchitis (CLASSIC-PBB): a non-randomised, internally controlled, multicentre trial",
  "uid": "14330830-b39e-546c-8e67-ddf3d607b6f9"
}