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|
|Kahn and Jones||18||Co-1||2||26||9||6||5||6|
|Chastre et al||13||St-v||1||22||15||3||2||2|
|Kirkpatrick and Bass||8||Co-n||1||16||14||2|
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|
|Kahn and Jones||13||Immuno||150||10® cfu/ml||19||2||17|
|Thorpe et al*t||15||240||104 cfu/ml||17||2||15|
|Chastre et al||5||Vent||100||104 cfu/ml||15||4||5||2||4|
|Torres et al||25||Vent||150||103 cfu/ml||52||22||12||14||4|
|Guerra and Baughman||18||Vent||240||104 cfu/ml||18 (22)§||2||7||9|
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