Diagnostic Value of Nasopharyngeal Aspirates in Children with Lower Respiratory Tract Infections

• Published in: Chinese medical journal Vol. 130; no. 6; pp. 647 - 651
• Main Authors: Lu, Ai-Zhen, Shi, Peng, Wang, Li-Bo, Qian, Li-Ling, Zhang, Xiao-Bo
• Format: Journal Article
• Language: English
• Published: China Medknow Publications and Media Pvt. Ltd 20.03.2017; Lippincott Williams & Wilkins Ovid Technologies; Department of Respiratory, Children's Hospital of Fudan University, Shanghai 201102, China%Department of Information Management, Children's Hospital of Fudan University, Shanghai 201102, China; Center for Evidenced-based Medicine, Fudan University, Shanghai 200032, China; Medknow Publications & Media Pvt Ltd; Wolters Kluwer
• Subjects: Accuracy; Acinetobacter baumannii - isolation & purification; Acinetobacter baumannii - pathogenicity; Adenoviruses; Adolescent; Age; Bacteria; Bacterial infections; Bronchoalveolar Lavage; Diagnostic Accuracy; Lower Respiratory Tract Infection; Nasopharyngeal Aspirate; Child; Child, Preschool; Children; Children & youth; Clinical Laboratory Techniques - methods; Cystic fibrosis; Diagnosis; Enterobacter aerogenes - isolation & purification; Enterobacter aerogenes - pathogenicity; Escherichia coli - isolation & purification; Escherichia coli - pathogenicity; Female; Haemophilus influenzae - isolation & purification; Haemophilus influenzae - pathogenicity; Health aspects; Humans; Infant; Laboratories; Male; Nasopharyngeal cancer; Nasopharynx - microbiology; Organisms; Original; Pneumonia; pneumoniae; Polymerase chain reaction; Prospective Studies; Pseudomonas aeruginosa - isolation & purification; Pseudomonas aeruginosa - pathogenicity; Respiratory tract infections; Respiratory Tract Infections - diagnosis; Respiratory Tract Infections - microbiology; Risk factors; Sensitivity and Specificity; Staphylococcus aureus - isolation & purification; Staphylococcus aureus - pathogenicity; Streptococcus infections; Streptococcus pneumoniae - isolation & purification; Streptococcus pneumoniae - pathogenicity; Suctioning; Viruses; 儿童; 分泌物; 副流感病毒; 呼吸道合胞病毒; 急性呼吸道感染; 支气管肺泡灌洗液; 诊断价值; Bronchoalveolar Lavage; Lower Respiratory Tract Infection; Nasopharyngeal Aspirate; Diagnostic Accuracy
• ISSN: 0366-6999; 2542-5641
• DOI: 10.4103/0366-6999.201595

Background： The accuracy of nasopharyngeal aspirate （NPA） specimens in detecting lower respiratory pathogens remains controversial. The objective of this study was to evaluate the diagnostic accuracy of aspirates （NPAs） specimen in lower respiratory tract infections （LRTIs） in children. Methods： The prospective study was designed to collect the data of paired NPAs and bronchoalveolar lavage fluids from children with acute LRTIs from January 2013 to December 2015. All specimens were subjected to pathogen detection： bacterial detection by culture, Mvcoplasma pneumoniae （Mp） detection by polymerase chain reaction assay and virus （influenza A and B viruses, parainfluenza virus [PIV] Types 1 and 3, respiratory syncytial virus, and adenovirus） detection by immunofluorescence assay. The diagnostic accuracy analysis of NPAs was stratified by age ≤3 years （n = 194） and 〉3 years （n = 294）. Results： We collected paired specimens from 488 children. The positive rate of pathogen was 61.6%. For Streptococcus pneumoniae, NPA culture had the specificity of 89.9% and negative predictive value of 100% in age ≤3 years, the specificity of 97.2% and negative predictive value of 98.9% in age 〉3 years. For Mp, the positive predictive values of NPA was 77.4% in children ≤3 years, and 89.1% in children 〉3 years. For PIV III, NPA specimen had the specificity of 99.8% and negative predictive value of 96.5% in children ≤3 years. For adenovirus, NPA had the specificity of 97.8% and negative predictive value of 98.4% in age ≤3 years, the specificity of 98.9% and negative predictive value of 99.3% in age 〉3 years. Conclusions： NPAs are less invasive diagnostic respiratory specimens, a negative NPA result is helpful in ＂rule out＂ lower airway infection; however, a positive result does not reliably ＂rule in＂ the presence of pathogens.