Two studies have investigated the value of bronchoscopy in patients with CAP who failed to improve with antibiotic therapy.- Ortqvist et al evaluated 11 patients receiving treatment for more than three days. Quantitative bacterial cultures of the PSB were negative in nine patients, five had adequately treated Streptococcus pneumoniae, one had Legionella (growth in bronchial secretions and serology), one had adenovirus (serology), and two had no definitive diagnosis established. The remaining two patients had a significant (>103 cfu/ml) growth of a-hemolytic Streptococcus. antibiotics levaquin
Feinsilver et al subjected to FOB with BAL 35 consecutive patients with presumed nonresolving (clinically and roentgenographically) pneumonia who had been receiving antibiotic therapy for at least seven days. Fourteen patients (40 percent) had a diagnosis other than bacterial pneumonia, and FOB was diagnostic in 12. Eight diagnoses were established with BAL cytology: four carcinoma, three Pneumocystis, and one cytomegalovirus. The BAL cultures were positive in three patients: two tuberculosis and one actinomycosis. One patient had eosinophilic pneumonia diagnosed by transbronchial biopsy specimen. Twenty-one patients who had no specific diagnosis made and had complete resolution of the roentgeno-graphic infiltrate were believed to have bacterial pneumonia. No information, however, was provided on the result of (conventional) bacterial cultures or on change in antibiotic treatment in these patients.
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