ACUTE COMMUNITY-ACQUIRED PNEUMONIA - CASE S OF INTERMEDIATE AND GREATSEVERITY INVESTIGATED BY BRONCHOFIBROSCOPY

Between February 1989 and June 1994 193 cases of acute community acqui red pneumonia (PAC) which were of intermediate or great severity were admitted to two hospitals in the South West of France. These patients were explored using bronchofibroscopy (FB) with a protected brush (BP) and alveolar microlavage (MLBA) and quantitative cultures were perfor med also there were other specimens taken in a regular,fashion. The pe rcentage of positive examinations was 60% for brushings (BP) 59% for M LBA and 21% for blood cultures and 16% for serological tests. An aetio logy was determined in 137 cases (70.9%). The organisms recovered were Streptococcus pneumoniae (49.6%), gram negative bacilli (17.4%), Haem ophilus influenzae (11.7%), Mycoplasma pneumoniae (4.4%), Mycobacteriu m tuberculosis (4.4%), Staphylococcus aureus (3.6%), Chlamydia pneumon iae (2.2%), Legionella pneumophila (0.7%), and various 5.8%. The overa ll mortality was 15% despite immediate antibiotics based on the likely organism in 88% of cases. The study of prognostic factors confirmed t he Fine score system (determined a posteriori) which constitutes a use ful and practical index determining the management of PAC. On the othe r hand the role of bacteriological documentation in improving the vita l prognosis remains to be confirmed. If bronchofibroscopy has appeared to us as a safe and useful means of investigation, the manage ment of these disease remains to specified. We suggest that its use is reserv ed for subjects with life threatening disease (a Fine score equal to o r greater than 3) or for those patients who are likely to have unusual germs: failure of previous antibiotics, diabetes, malnourishment, can cer, airflow obstruction and inhalation.