RT Journal Article SR Electronic T1 How to use: bacterial cultures in diagnosing lower respiratory tract infections in cystic fibrosis JF Archives of disease in childhood - Education & practice edition JO Arch Dis Child Educ Pract Ed FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health SP 181 OP 187 DO 10.1136/archdischild-2012-303408 VO 99 IS 5 A1 Ahmed, Bushra A1 Bush, Andrew A1 Davies, Jane C YR 2014 UL http://ep.bmj.com/content/99/5/181.abstract AB Respiratory infections are the leading cause of morbidity and mortality in cystic fibrosis. Certain bacteria, such as Pseudomonas aeruginosa, are associated with a worse clinical outcome than others, but can be completely eradicated if identified and treated early. The diagnosis of lower respiratory tract infections can be challenging in the non-expectorating patient, in whom upper airway samples, such as cough swabs, are a surrogate for lower airway sampling. However, the results of these often do not fit with the clinical picture, presenting a management dilemma. Frequently, clinicians are faced with a negative culture result in a progressively symptomatic patient and vice versa. When judging the clinical significance of a positive upper airway culture result in an asymptomatic patient, it is important to consider the prognostic significance of the organism cultured. Given that the reported sensitivity of upper airway swabs (which includes throat swabs) is variable, ranging from 35.7% to 71% for Pseudomonas aeruginosa, 50% to 86% for Staphylococcus aureus and 11% to 92% for Haemophilus influenza, upper airway samples may fail to identify lower airway infections. Therefore, in symptomatic children, a repeatedly negative upper airway swab should not be considered as reassuring, and alternative sampling methods, such as induced sputum or bronchoalveolar lavage, should be considered. Here we use some examples of common scenarios to illustrate how best to use bacterial cultures to aid management decisions in cystic fibrosis.