In a baboon model of respiratory failure, the results of quantitative cultures of BAL and PSB were compared with the histologic and bacteriologic findings of open-lung biopsy. Six ventilated animals not receiving antibiotics had, on histologic examination, moderate to severe pneumonia and a polymicrobial growth on culture; BAL recovered 74 percent of all species present in the lung tissue compared with 41 percent by PSB and 56 percent by ‘needle aspirate. Bacterial growth in the BAL, expressed as bacterial index (sum of all the logarithmic concentrations of individual organisms), was linearly related to tissue values.
Tissue cultures had a mean growth of 2.8 species at 103 cfu/g and 1.4 species at 104 cfu/g. In animals receiving antibiotics, absence of growth was frequently found despite histologic evidence of pneumonia. The investigators concluded that BAL specimens, by sampling a larger area of lung parenchyma, provided (in animals not receiving antibiotics) the most accurate window on lung microbiology, both quantitatively and qualitatively. Buy Advair Diskus Online
Three investigators have evaluated the role of BAL in diagnosing nosocomial bacterial pneumonia in patients receiving mechanical ventilation. Torres et al have compared the diagnostic yield of PSB and BAL in 25 patients with VAP recently (^12 h) placed on antibiotic therapy.
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