Abstract
Purpose
To explore the effectiveness of flexible bronchoscopy in pediatric Mycoplasma pneumoniae pneumonia (MPP).
Methods
This retrospective cohort study included children with MPP admitted between 2016 and 2019 in Shanghai. Tracheobronchial manifestations, etiologic findings, therapeutic effect, and health-economic indicators were assessed in bronchoscopy (plus bronchoalveolar lavage (BAL)) and non-bronchoscopy group. We used propensity-score matching and multivariable logistic regression to investigate the effect of bronchoscopy and BAL on disease recovery.
Results
In 900 children with MPP, 24/278 (8.6%) of those who underwent bronchoscopy had sputum plugs. Coinfection rate was four-fold enhanced by BAL (19.6% vs. 4.5%, p < 0.01) in patients with severe MPP (SMPP) and nearly doubled (10.8% vs. 5.9%, p = 0.03) in those without SMPP, compared with no BAL. Total of 224 (24.9%) patients had multilobar consolidation; after BAL, a significantly shorter lesion-resolution duration was observed on imaging (OR: 0.2, 95% CI: 0.0−0.7). However, longer fever duration (OR: 2.8, 95% CI: 1.7−4.8), hospital stay (OR: 3.1, 95% CI: 1.9−5.1), and higher costs were found in the bronchoscopy group than in the non-bronchoscopy group.
Conclusions
Through BAL, coinfection may explain one-fifth of causes for SMPP. Bronchoscopy with BAL may increase the detection rate of pathogen and resolve pulmonary lesions in patients with multilobar consolidation.
Impact
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Flexible bronchoscopy with bronchoalveolar lavage is of great assistance in the timely detection of coinfection, sputum plug and inflammatory polyps in children with Mycoplasma pneumoniae pneumonia (MPP), and improves the recovery of lung damage in MPP patients with multilobar consolidation.
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This study provides new insights into the indications of flexible bronchoscopy for the diagnosis and treatment of pediatric patients with MPP.
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Acknowledgements
We thank all participants and staff of this study and the physicians at the Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine. This work was supported by the National Natural Science Foundation of China under grant numbers 81874265 and 82073561; Research Physician of the Peak Plateau Project of Shanghai Municipal Education Commission under grant number 2020002; Shanghai Science and Technology Commission under grant numbers 18411966600 and 19410740800; National Respiratory Field Key Laboratory Emergency Project numbers EKPG21-08 and National Ministry of Science and Technology-National Key R&D Program Project numbers 2021YFE0201900.
Funding
This work was supported by the National Natural Science Foundation of China under grant numbers 81874265 and 82073561; Research Physician of the Peak Plateau Project of Shanghai Municipal Education Commission under grant number 2020002; Shanghai Science and Technology Commission under grant numbers 18411966600 and 19410740800; National Respiratory Field Key Laboratory Emergency Project numbers EKPG21-08 and National Ministry of Science and Technology-National Key R&D Program Project numbers 2021YFE0201900.
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L.W. and Q.X. conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. S.X., H.L., L.Z. and J.A. collected data, carried out the initial analyses, and reviewed and revised the manuscript. Q.L., C.C., and X.Z. coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. L.H. and W.Z. designed the study and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for the content of the work.
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Ethics approval
This study was approved by the Ethics Committee of Xinhua Hospital (XHEC-C-2018-107). This study was conducted in accordance with the Declaration of Helsinki.
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Wang, L., Xie, Q., Xu, S. et al. The role of flexible bronchoscopy in children with Mycoplasma pneumoniae pneumonia. Pediatr Res 93, 198–206 (2023). https://doi.org/10.1038/s41390-021-01874-z
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DOI: https://doi.org/10.1038/s41390-021-01874-z
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