Diagnostischer Wert der bronchoalveolären Lavage bei Patienten mit opportunistischer und nicht opportunistischer bakterieller Pneumonie

Dalhoff, K; Braun, J.; Hollandt, H.; Lipp, R. W.; Kj, Wiessmann; Marre, R.

doi:10.1007/bf01712447

Cited by 16 publications

(17 citation statements)

References 20 publications

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“…The bacterial spectrum isolated in our patients corresponded to the spectrum obtained in other studies in immunocompromised host with Streptococcus and Staphylococcus species isolated most frequently [7,9,11]. Most common organisms found in immunocompromised patients by Eriksson et al [9] were alpha-hemolytic streptococci, coagulase-negative staphylococci, enterococci, and Neisseria species.…”

Section: Discussionsupporting

confidence: 84%

“…Additionally, most neutropenic patients with pneumonia receive antifungal drugs according to international guidelines [16,18,19,26]. It is known that previous antimicrobial treatment lowers the yield of BAL culture and is probably responsible for the low impact on treatment changes [4,5,7,9,30]. We could demonstrate as well, that positive bacterial BAL results were significantly less common in patients who underwent antibacterial prophylaxis than in patients who did not.…”

Section: Discussionmentioning

confidence: 53%

“…In neutropenic patients with infection, prompt antimicrobial treatment is mandatory and it should not be delayed by any diagnostic procedure [7,13,23]. Additionally, most neutropenic patients with pneumonia receive antifungal drugs according to international guidelines [16,18,19,26].…”

Section: Discussionmentioning

confidence: 99%

“…Maschmeyer et al [19] defined the isolation of these microorganisms from BAL fluid as etiologically insignificant findings for lung infiltrates. However, there are some authors suggesting that immunocompromised patients may develop pneumonia from these microorganisms [7,17,28].…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic implication of BAL in patients with neutropenia

Kuehnhardt

Hannemann²,

Schmidt³

et al. 2009

Ann Hematol

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Bronchoalveolar lavage (BAL) is a practicable procedure establishing the etiology of pneumonia. In patients with neutropenia, empirical antimicrobial treatment is mandatory immediately after diagnosis of infection, usually before results of BAL are available. We evaluated the impact of BAL on treatment and outcome of pneumonia in immunocompromised patients with a special regard to neutropenia. Bronchoscopy with BAL was performed in 58 episodes of clinical documented pneumonia in patients with hematological malignancies (88%) or solid tumors (12%), in 30 cases patients had neutropenia, in 28 cases patients had no neutropenia. In 93% of cases, BAL was performed under empirical antimicrobial treatment. BAL fluid was cultivated for bacteria, fungi, and tested for Pneumocystis jirovecii and cytomegalovirus (CMV). BAL revealed positive bacterial results in 67% of cases. Gram-positive microorganisms were detected in 95% of positive BAL results, gram-negative microorganisms in 23%, mixed bacterial cultures occurred in 41%. Positive fungi cultures were found in 59%. P. jirovecii was detected in 5% of cases tested and CMV in 8%. There was no significant difference between neutropenic and non-neutropenic patients. BAL results directed a change of therapy in only six of 58 episodes (5%). Overall mortality related to pneumonia was 16%. In this patient setting, the yield of BAL rarely has a significant influence on treatment and outcome of pneumonia. The early beginning of antimicrobial treatment reduces the diagnostic yield of BAL. In patients with pneumonia during neutropenia, its use should be well considered.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Therapeutic implication of BAL in patients with neutropenia

Kuehnhardt

Hannemann²,

Schmidt³

et al. 2009

Ann Hematol

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“…In several studies, BAL culture has been used to establish the aetiology of LRTI [5,[23][24][25][26][27][28][29]. …”

Section: Discussionmentioning

confidence: 99%

Evaluation of a multiplex PCR for bacterial pathogens applied to bronchoalveolar lavage

Strålin

Korsgaard²,

Olcén³

2006

European Respiratory Journal

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The present study assessed the diagnostic usefulness of a multiplex PCR (mPCR) for Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae and Chlamydophila pneumoniae applied to bronchoalveolar lavage (BAL).Fibreoptic bronchoscopy was performed on 156 hospitalised adult patients with lower respiratory tract infection (LRTI) and 36 controls. BAL fluid was analysed with bacterial culture and mPCR.By conventional diagnostic methods, S. pneumoniae, H. influenzae, M. pneumoniae and C. pneumoniae were aetiological agents in 14, 21, 3.2 and 0% of the LRTI patients, respectively. These pathogens were identified by BAL mPCR in 28, 47, 3.2 and 0.6% of cases, respectively, yielding sensitivities of 86% for S. pneumoniae, 88% for H. influenzae, 100% for M. pneumoniae and 0% for C. pneumoniae, and specificities of 81, 64, 100 and 99% for S. pneumoniae, H. influenzae, M. pneumoniae and C. pneumoniae, respectively. Of the 103 patients who had taken antibiotics prior to bronchoscopy, S. pneumoniae was identified by culture in 2.9% and by mPCR in 31%. Among the controls, mPCR identified S. pneumoniae in 11% and H. influenzae in 39%.In lower respiratory tract infection patients, bronchoalveolar lavage multiplex PCR can be useful for identification of Streptococcus pneumoniae, Mycoplasma pneumoniae and Chlamydophila pneumoniae. The method appears to be particularly useful in patients treated with antibiotics.

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