Utilisation des outils diagnostiques microbiologiques dans les infections pulmonaires communautaires

Deschamps, C.; Lacombe, Karine; Lalande, V.; Meyohas, M.C.; Girard, Pierre‐Marie; Meynard, J.-L.

doi:10.1016/s0755-4982(04)98972-5

Cited by 4 publications

(2 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Deschamps et al . observed a similar identification rate in the context of hospital-acquired pneumonia with BAL and blood cultures [15]. Pathogen identification is more successful when FODP mini-BAL is performed before antibiotic therapy (76.2% versus 27.3%; P < .001; relative risk of non-identification was 3.3 (95% confidence interval, 1.5 to 7.25).…”

Section: Discussionmentioning

confidence: 73%

“…Deschamps et al reported a 40% identification rate with BAL and 5.7% with blood cultures in patients with hospital-acquired pneumonia [15]. According to these previous results, we calculated that 49 patients were required in order to have an 80% power for detecting a 25% absolute difference in pathogen identification between the fiberoptic and blood culture techniques with a two-sided chi-square test and α set at 0.05.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2013

View full text Add to dashboard Cite

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

show abstract

Section: Discussionmentioning

confidence: 73%

Section: Methodsmentioning

confidence: 99%