Comparison of Bronchoalveolar Lavage and Mini-Bronchoalveolar Lavage in the Diagnosis of Pneumonia in Immunocompromised Patients

Abstract

Background: Pneumonia is a major cause of morbidity and mortality in immunocompromised patients. Bronchoalveolar lavage (BAL) is commonly used to help diagnose and characterize pneumonia in these patients. Mini-BAL is a less-invasive, less-costly and less-cumbersome diagnostic tool than BAL. Objectives: In this study, we compared the diagnostic value of BAL and mini-BAL in the evaluation of pneumonia in immunocompromised patients with respiratory failure. Methods: Sixty-four respiratory samples were collected from 32 immunocompromised patients admitted to our respiratory intensive care unit with a clinical diagnosis of pneumonia and respiratory failure requiring invasive mechanical ventilation. A single BAL sample and a single mini-BAL sample were collected from each patient. Samples were examined for bacteriologic, mycologic, mycobacteriologic, and viral organisms. Results: The mean age of the patients was 56.0 ± 14.4 years. Of the 32 BAL samples, bacterial isolates were detected in 11 patients (34.4%) and on the other hand bacterial isolates were detected in 10 patients (31.3%) of the mini-BAL samples. Fungal isolates were detected in 11 patients (34.4%) from BAL samples and 13 patients (40.6%) from mini-BAL samples. Our analysis demonstrated a strong positive correlation between the results of BAL and mini-BAL testing (r = 0.850 and r = 0.821, respectively). Conclusion: In this study, we demonstrated a strong correlation between the isolation rates of bacteria and fungi in BAL and mini-BAL samples obtained from immunocompromised patients with pneumonia and respiratory failure. The data strongly support the use of mini-BAL sampling in such patients as a less-invasive, less-costly and simpler alternative to traditional BAL.

Evaluation of Microorganisms Causing Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit

“…However, the clinical and laboratory features suggested that contamination was not involved, because the mini-BAL technique was used to isolate the causative agents. The interpenetration of the two catheters minimizes the contamination risk [20]. gram-negative bacteria are the principal cause of VAP (98% of our cases) [21].…”

The retrospective analysis of the value of endotracheal aspirate cultures for the diagnosis of ventilator-associated pneumonia in pediatric intensive care unit

“…Ancak bu yöntemin oldukça invaziv olması ve yapılma zorluğu, non-invaziv yöntemlerin tercih edilmesi gerekliliğini ortaya çıkarmıştır (9). Literatürde, mini-BAL ve bronkoskopik fırça yöntemleri karşılaştırıldığında aralarında güçlü bir korelasyon olduğu (% 77-88) rapor edilmiştir (12)(13)(14)(15). Bununla birlikte Khilnani ve ark.…”

“…CAYD 2015;2(1): [13][14][15][16][17][18] prospektif kontrollü çalışmalarla desteklenmesi gerektiği aşikardır. Biz, CDC kriterlerine göre VİP düşünülen hastalarda mikrobiyolojik kanıt ve skorlama için ETA-KPES değerlendirmesinin faydalı olacağı kanaatindeyiz.…”

The role of endotracheal aspiration in the diagnosis of ventilator associated pneumonia

“…Radyolojik olarak yeni ya da ilerleyici infiltrasyon, 2. Ateş yüksekliği (≥ 38°C), 3. Lökositoz (≥ 12.000/mm 3 ) ve 4.…”

“…Bronkoskopik yöntem-lerin duyarlılık ve özgüllük oranları yüksektir. Ayrıca, bronkoskopik BAL veya korumalı fırçalama; klinik olarak infeksiyon bulgularından daha objektif bilgi vermesi, etkenin kantitatif kültürlerde üretilmesi ve antibiyotik tedavisinin planlanmasına olanak sağlaması nedeniyle tercih edilmektedir (3,4). Ancak bu yöntemlerin uygulanmasındaki kısıtlılıklar, yaygın olarak kullanıl-masını engellemektedir.…”