J. Chastre et al., EVALUATION OF BRONCHOSCOPIC TECHNIQUES FOR THE DIAGNOSIS OF NOSOCOMIAL PNEUMONIA, American journal of respiratory and critical care medicine, 152(1), 1995, pp. 231-240
Citations number
28
Categorie Soggetti
Emergency Medicine & Critical Care","Respiratory System
To compare the usefulness of specimens obtained by bronchoalveolar lav
age (BAL) and using a protected specimen brush (PSB) in the diagnosis
of nosocomial pneumonia, both procedures were performed via fiberoptic
bronchoscopy just after death in a series of 20 ventilated patients w
ho had not developed pneumonia before the terminal phase of their dise
ase and who had no recent changes in antimicrobial therapy. These resu
lts were compared with both histologic and microbiologic postmortem lu
ng features in the same area. The total number of bacteria obtained by
culture of lung segments and the latters' histologic grade were close
ly correlated (p = 0.79, p < 0.0001). PSB and BAL quantitative culture
results were strongly correlated with lung tissue values (p = 0.67 an
d 0.75, respectively; p < 0.0001). Using discriminative values of grea
ter than or equal to 10(3) and greater than or equal to 10(4) bacteria
/g to define positive PSB and BAL cultures, respectively, these techni
ques identified lung segments yielding greater than or equal to 10(4)
bacteria/g tissue with sensitivities of 82 and 91% and specificities o
f 89 and 78%, respectively. Moreover, upon direct observation, the per
centage of BAL cells containing intracellular bacteria was closely cor
related with the total number of bacteria obtained from corresponding
lung samples (p < 0.001). These findings indicate that bronchoscopic P
58 and BAL samples very reliably identify both qualitatively and quant
itatively microorganisms present in lung segments with bacterial pneum
onia, even when the infection develops as a superinfection in a patien
t already receiving antimicrobial treatment for several days.