Microscopic analysis of the cytocentrifugated BAL can identify the type of bacteria (Gram reaction) invading the lower airways and the presence of an active inflammatory response (neutrophils with intracellular organisms). The presence of 1 percent or less SEC indicates that the sample is not heavily contaminated by oropharyngeal flora and increases the diagnostic value of cultures results.
The difference in the diagnostic breakpoint of bacterial growth (103 to 105 cfu/ml) reported by various investigators depends on the type of microbiologic processing used and the relationship of two variables: (1) the concentration of pulmonary pathogens in the retrieved BAL fluid, and (2) the degree of contamination of the bronchoscopic channel through which the fluid is injected and aspirated back. ventolin 100 mcg
The sensitivity value of BAL in identifying patients with bacterial pneumonia rests on BALs capacity of recovering organisms at a significant concentration. The recovery of bacteria from the distal airways is affected by the amount of fluid injected, the concentration of organisms in the lung and its dilution with BAL fluid, and the quantity of fluid retrieved. The specificity value of BAL cultures in excluding bacterial pneumonia has been limited in part by contamination with upper airway bacteria that are found to a significant degree (>104 cfu/ml) in one third of specimens (Table 1).
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