Evaluation of early mini-bronchoalveolar lavage in the diagnosis of health care-associated pneumonia: a prospective study

Abstract

IntroductionHealth care-associated pneumonia (HCAP) has been proposed as a new category of respiratory infection to identify patients at risk of multidrug-resistant (MDR) pathogens. The American Thoracic Society's recommendation for HCAP treatment is to use broad-spectrum and multiple antibiotics. However, this strategy may be economically expensive and promote antimicrobial resistance when a multisensitive pathogen is not identified.MethodsWe prospectively included all patients presenting with HCAP in the emergency department. Blood cultures and fiberoptic bronchoscope-guided distal protected small volume bronchoalveolar lavage (FODP mini-BAL) were performed in each patient. Empirical antibiotic therapy was adapted when microbiological findings were available. The primary objective was to assess whether FODP mini-BAL is more efficient than blood cultures in identifying pathogens with the ratio of identification between both techniques as principal criteria.ResultsWe included 54 patients with HCAP. Pathogens were identified in 46.3% of cases using mini-BAL and in 11.1% of cases using blood cultures (P <0.01). When the patient did not receive antibiotic therapy before the procedure, pathogens were identified in 72.6% of cases using mini-BAL and in 9.5% of cases using blood cultures (P <0.01). We noted multidrug-resistant pathogens in 16% of cases. All bronchoscopic procedures could be performed in patients without complications.ConclusionsFODP mini-BAL was more efficient than blood cultures for identifying pathogens in patients presenting with HCAP. When bacteriological identification was obtained, antibiotic therapy was adapted in 100% of cases.See related letter by Sircar et al.,http://ccforum.com/content/17/2/428

Effects of Bronchoalveolar Lavage on RefractoryMycoplasma pneumoniaePneumonia

“…Lacroix et al 31 have demonstrated that BAL was safe and more efficient than blood culture to detect pathogens in patients presenting with pneumonia. In our results, we found that BAL was a more effective method to identify pathogens than nasopharyngeal secretion detection (89% vs 63%, P ϭ .01).…”

Inhibition of the PI3K/AKT Signaling Pathway or Overexpression of Beclin1 Blocks Reinfection of Streptococcus pneumoniae After Infection of Influenza A Virus in Severe Community-Acquired Pneumonia

“…BAL is a noninvasive method, hence safe for patients. A previous study has suggested that BAL could be a useful tool in the identification of pathogens in ventilator-associated pneumonia, or in acute hypoxemic respiratory failure which requires noninvasive ventilation [31]. Another literature also has elucidated the utility of BAL acting as a less invasive option for the assessment of lung pathology, which could also aids in the diagnosis of Cytomegalovirus pneumonitis using molecular methods [32].…”

The Challenging Diagnosis of Non-Community-Acquired Pneumonia in Non-Mechanically Ventilated Subjects: Value of Microbiological Investigation

“…Moreover, an alternative diagnosis was obtained in more than half of the subjects suspected of pneumonia and in whom the microbiological investigation was eventually negative, again emphasizing the complexity of the clinical diagnosis and the need for performing microbiological investigation in this context. 1,30 It is worth pointing out that suspected HAP cases were more often investigated than HCAP, because of the physicians' reluctance to perform fiber-optic bronchoscopy and invasive samplings in older, more fragile and comorbid subjects.…”