The Role of Bronchoalveolar Lavage in Diagnosing Nonopportunistic Bacterial Pneumonia (7)

In: Pulmonary function

29 Apr 2013

The Role of Bronchoalveolar Lavage in Diagnosing Nonopportunistic Bacterial Pneumonia (7)Bacterial Pneumonia
Recent human and animal studies have investigated the diagnostic value of BAL in various clinical settings: normal noninfected host, immunosuppressed patient, community-acquired pneumonia (CAP), and ventilator-associated pneumonia (VAP). Tables 1 and 2 summarize the findings of those investigations that have reported the results of quantitative bacterial cultures of BAL effluent in patients with and without pneumonia. Antibiotic exposure prior to collecting respiratory secretions significantly affects the result of cultures, with a high rate of false negative findings.^ The growth of microorganisms in BAL quantitative cultures is decreased to a nonsignificant concentration within 48 to 72 h of effective antibiotic treatment. Pertinent information on treatment with antibiotics will be provided for each study. buy flovent inhaler
Normal Noninfected Host
In eight normal volunteers, Kirkpatrick and Bass found BAL to yield sterile growth in only one specimen and PSB in seven. Bronchoalveolar lavage, obtained after injecting lidocaine over the vocal cords, grew all contaminants at a concentration below 104 cfu/ml.

Table 1—Result of BAL Quantitative Culture m Patients without Pneumonia

Source No. of Patients Type* NoGrowth No. of Isolates Colony Forming Units/ml
CIO >10* ^lO >10“
Kahn and Jones 18 Co-1 2 26 9 6 5 6
44t St-i 5 55 10 12 19 14
Chastre et al 13 St-v 1 22 15 3 2 2
Kirkpatrick and Bass 8 Co-n 1 16 14 2
Total 83 9 119 48 23 26 22
Percent 11 100 40 20 21 18

Table 2—Result of Bronchoalveolar Lavage Culture in Patients with Bacterial Pneumonia

Patients Type* BAL Amount, ml SignificantGrowth No. of Isolates -y-Colony Forming Units/mli
<10* 2£l(P 2S104 sslO*
Kahn and Jones 13 Immuno 150 10® cfu/ml 19 2 17
15/15
Thorpe et al*t 15 240 104 cfu/ml 17 2 15
15/15
8 Immuno 240 104 cfu/ml 8 8
8/8
Chastre et al 5 Vent 100 104 cfu/ml 15 4 5 2 4
4/5
Torres et al 25 Vent 150 103 cfu/ml 52 22 12 14 4
17/25
Guerra and Baughman 18 Vent 240 104 cfu/ml 18 (22)§ 2 7 9
16/18
Total 84 74 129 28 17 35 49
Percent 86 100% 22 13 27 38

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