Thorpe et al analyzed the BAL fluid with quantitative bacterial cultures at one dilution, plating 0.01 ml of BAL directly into the culture media, and found a growth above 104 cfu/ml in all 23 of their patients with pneumonia and in only 4 of 58 without pneumonia. Gram stain of the cytocentrifugated BAL fluid was positive (one or more organisms seen per 1,000 X field) only in those with bacterial pneumonia and had a sensitivity of 73 percent. Seven patients who had clinical progression of their pneumonia, despite use of seemingly adequate antibiotics, responded to a treatment change directed to the organism^) recovered in significant concentration. Eight (21 percent) of 39 immunosuppressed patients with microbial-related infiltrates proved to have acute bacterial pneumonia by BAL cultures and responded to appropriate therapy. buy cheap antibiotics
In patients with CAP admitted to the hospital, a satisfactory sputum sample can be obtained in less than 50 percent. Although for most patients invasive procedures cannot be justified, their role has been investigated in the one who requires admission to the intensive care unit (ICU) or in those who fail to improve with antibiotic treatment. Bronchoscopy with collection of distal respiratory secretions by either PSB or BAL frequently has been shown to provide a diagnosis otherwise not obtainable by noninvasive means.
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