The following suggestions are derived from our own experience and from a critical review of the published literature, which is limited in part by the lack of uniformity in patients’ selection and laboratory processing. proventil inhaler
1/ Bacterial Pneumonia: Best results with BAL bacterial cultures are obtained when bronchoscopy is performed in patients not receiving antimicrobials and when the fluid recovered has a low degree of contamination. In patients receiving antibiotics, results of BAL quantitative cultures frequently can be falsely negative and occasionally falsely positive (colonization of the lower airways vs contamination). Several investigators, however, have also reported a significant bacterial growth in the BAL of patients with pneumonia, despite concomitant antibiotic administration. The significant organisms were frequently not sensitive to the administered antibiotic and the result of cultures were useful in redirecting therapy.
In a small but significant percentage of immunosuppressed patients, diffuse infiltrates on chest roentgenogram are caused by infectious agents other than opportunistic ones.* When diagnostic bronchoscopy is performed in these patients, analysis of the BAL fluid could incorporate testing for “conventional” bacteria.
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