Pathogen spectrum in the children with foreign body aspiration in southwest China

Foreign body aspiration (FBA) may be complicated by secondary respiratory tract infection. The spectrum of pathogens associated with FBA in China remains poorly described. This study aimed to obtain contemporary data on the distribution of organisms among children with FBA in southwest China. We conducted a large-scale retrospective cohort study on children diagnosed with FBA via flexible bronchoscopy between 2017 and 2024. Bronchoalveolar lavage fluid (BALF) specimens were collected for microbial cultures, followed by comprehensive analyses of the pathogen spectrum. Among 862 FBA children, 256 (29.7%) had positive BALF cultures and 277 pathogens were detected. Compared to negative BALF culture group, the positive group was more likely to inhale sharp FB (p < 0.001) and have preoperative fever (p = 0.020), longer retention time of FB (p = 0.020) and longer hospital stay (p < 0.001). There were 193 (69.7%) Gram-negative bacteria, 67 (24.2%) Gram-positive bacteria and 17 (6.1%) fungi. Haemophilus influenzae (39.7%), Staphylococcus aureus (18.7%) and Enterobacter cloacae (7.9%) were the most frequently identified pathogens. All 17 Cases detected with fungal pathogens were clinically cured without antifungal medications. Preoperative fever, prolonged FB retention time and inhalation of sharp FB were risk factors for secondary infections associated with FBA. Antibacterial treatment might be considered in these cases. Haemophilus influenzae, Staphylococcus aureus and Enterobacter cloacae were the most common pathogens. FBA may pose a risk of fungal colonization even in immunocompetent children.