الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Non-resolving pneumonia is the term used in case that clinical
manifestation of pneumonia failed to improve in spite of 10 days of appropriate
treatment or persistence of radiological finding within 12 weeks (Marrie TJ ,
1993 ).
It is one of the greatest challenges faced by the pulmonologists today and
the cause of about 15% of pulmonary consultations that require admission at
hospitals and 8% of bronchoschopies (Marrie TJ , 1993).
Many factors can affect the course of pneumonia and delay the
improvement including those relating to etiology as presence of resistant or
unusual organisms , those relating to the host and its defense , development of
complication and disease mimicking pneumonia (Arancibia F etal., 2000(.
Identification of specific pathogen responsible for non-resolving
pneumonia will help to choose the appropriate treatment and improve the
outcome (Chang AB etal., 2018(.
Cultures collected by bronchoalveolar lavage are the “ gold standard “ in
diagnosis but bronchoscopy is an invasive method and needs a skilled personnel
( D’Sylva P etal., 2017( .
Cultures obtained by nasopharyngeal swab and gastric aspirate aren’t
proved yet as accurate tools for diagnosis although they are safer in comparison
with bronchoalveolar lavage (Armstrong DS etal., 1996 & Rosenfeld M et al.,
1999).
This prospective study included 52 children suffering from non-resolving
pneumonia who was admitted at Pediatric Department of Sohag University
Hospital . Three consecutive cultures ( Nasopharyngeal swab , gastric aspirate
and BAL cultures ) were collected from each child in our study and the results
were compared.
The results of our study confirm the importance of Bronchoscopy and
BAL in cases of non resolving pneumonia and proved that both Nasopharyngeal
swab and gastric aspirate cultures still have a low accuracy in cases of non-
resolving pneumonia.
Study limitation
Age group : we conducted this study from 1 month to 18 years age children .
Number of patient : we conducted only 52 patients in our study.
Study duration:
Only one year.
Conclusion :
In conclusion this study concluded that Nasopharyngeal swab and gastric
aspirate cultures have a low accuracy in cases of non-resolving pneumonia .
And bronchoscopy and BAL cultures is still the gold standard in diagnosis of
non-resolving pneumonia.
Recommendations :
Based on this study we recommended the pediatrician to :
- Good history and investigations help a lot in directing the pediatrician
toward the cause of non resolving pneumonia.
- Bronchoscopy if essential in most of the cases of non-resolving pneumonia .
- BAL culture help discovering the specific pathogen responsible for non-
resolving pneumonia and directing toward the appropriate antibiotic
treatment.
Summery and conclusion
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- NP swab and gastric aspirate culture may help in diagnosis but in most of
the cases they still have low accuracy.