DIAGNOSTIC-VALUE OF PROTECTED BAL IN DIAGNOSING PULMONARY INFECTIONS IN IMMUNOCOMPROMISED PATIENTS

Study objectives: To assess the diagnostic utility of protected BAL (P -BAL) in respiratory infections in immunocompromised patients and to e xamine whether P-BAL alone could substitute the combined use of protec ted specimen brush (PSB) and BAL in such patients. Patients and study design: Thirty-seven immunocompromised patients who underwent PSB, P-B AL, and BAL simultaneously for the diagnosis or exclusion of bacterial or nonbacterial opportunistic respiratory infections were studied pro spectively, The P-BAL was performed through the inner catheter of a te lescoping plugged catheter with 60 mL of saline solution. Main results : Thirteen (35%) cases of bacterial pneumonia were diagnosed, PSB obta ined seven true-positive (TP) results, P-BAL obtained nine, and BAL ob tained eight TP, Results of the three techniques were positive and con cordant in 6 of the 13 cases, PSB remained free of contamination from oropharyngeal flora in all cases, P-BAL was contaminated twice, and BA L was contaminated in four cases, Opportunistic respiratory infections were diagnosed in 19 patients, P-BAL results were identical to those with BGL in all cases: 18 TP and 1 false-negative, The average volume of P-BAL fluid retrieved was 19 mL, sufficient for all microbiologic a nd cytologic processings, P-BAL was more time-consuming than both PSB and BAL procedures and was technically more complex. Conclusion: P-BAL alone can substitute the combined use of both PSB and BAL in immunoco mpromised patients and attains a higher sensitivity than PSB in diagno sing bacterial pneumonia. The combined strategy continues to be a good choice, but due to the high incidence of bacterial pneumonia in these patients, a highly efficient diagnostic procedure is required not onl y for nonbacterial opportunistic respiratory infections but also for b acterial pneumonia.