Ortqvist et al subjected 24 patients with CAP admitted to the hospital to FOB with PSB. An etiologic diagnosis by noninvasive techniques was obtained in 13 (54 percent), while results of FOB verified the diagnosis in seven, added a pathogen in one (mixed infection), and revealed the diagnosis in six additional patients. The diagnostic sensitivity of PSB culture was much higher in patients who had bronchoscopy before initiating antibiotic therapy (80 vs 12 percent). antibiotic levaquin
Severe CAP requiring admission to the ICU carries a high mortality rate, and commonly used diagnostic techniques provide a correct diagnosis in only half the patients. In this context, Sorensen et al conducted a prospective study designed to explore the possibility of improving and speeding up the diagnostic process. Implementing a comprehensive protocol on admission to the ICU, they obtained an etiologic diagnosis in 81 percent of patients, in 53 percent within 48 to 72 hours. Bronchoscopy was performed in 29 patients, all receiving antibiotics, and cultures (BAL and PSB) were positive in 48 percent, compared with 42 percent with sputum and 22 percent with blood cultures. Bacterial cultures of BAL (nonquanti-tative) were positive in 38 percent and had a presumed specificity of 50 percent. In nine patients with CAP and respiratory failure who were receiving antibiotics (<12 h), Torres et al obtained a significant growth on both PSB and BAL quantitative cultures in only two (21 percent).
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