B. Barreiro et al., PROTECTED BRONCHOALVEOLAR LAVAGE IN THE DIAGNOSIS OF VENTILATOR-ASSOCIATED PNEUMONIA, The European respiratory journal, 9(7), 1996, pp. 1500-1507
The aim of this study was to evaluate the diagnostic efficacy of prote
cted bronchoalveolar lavage (PBAL) in ventilator-associated pneumonia
(VAP), and to determine the effect of antibiotic therapy on its microb
iological and cytological results. We prospectively studied 102 episod
es of suspected VAP in 93 patients, Subsequent follow-up confirmed VAP
in 35 of the 102 (34%) cases, In 55 of the 102 (55%) VAP was ruled ou
t, and the diagnosis remained undetermined in 12 of the 102 (12%) epis
odes. In the VAP group, 30 of the 35 (86%) PBAL (>10(4) colony-forming
units (cfu). mL(-1)) cultures were positive, In the non-VAP group, 5
of the 55 (9%) PBAL cultures were positive, A Giemsa stain of PBAL sam
ples was performed in 32 of the 35 cases of VAP, Intracellular organis
ms (ICO) were found in 24 of the 32 (75%) cases, Seven of the other ei
ght cases without evidence of ICO were already on antibiotics, In the
non-VAP group, ICO were present in only 1 out of 55 (2%) cases, The me
an ICO was significantly higher in the group who had not received anti
biotics when compared with those patients previously treated for less
than 48 h (p less than or equal to 0.01) and those treated for more th
an 48 h (p=0.009). The sensitivity of protected bronchoalveolar lavage
quantitative cultures was 87% and the specificity 91%. The sensitivit
y of cytological analysis for intracellular organisms was 75% and the
specificity 98%, According to our results, if the patient is already o
n antibiotics, the direct examination of protected bronchoalveolar lav
age fluid is less reliable, although still helpful.