Absence of bacterial colonization of the airways after therapeutic rigid bronchoscopy without stenting

Following airway stenting, bacterial colonization of the airways with poten tially pathogenic micro-organisms occurs within 4 weeks after treatment in the majority of patients. The objective of this study was to prospectively investigate whether nonstenting therapeutic rigid bronchoscopy (using laser , cryotherapy, mechanical dilatation or debridement) is followed by airway colonization or infection. Protected specimen brush sampling of the central airways and quantitative c ulture were performed immediately prior to, and 4 weeks after nonstenting t herapeutic rigid bronchoscopy in 20 consecutive patients with central airwa y lesions. Prior to therapeutic bronchoscopy, airway colonization/infection was presen t in nine of 20 (45%) patients. In these nine patients, 10 different potent ial pathogens were identified: Streptococcus pneumoniae (four cases), Pseud omonas aeruginosa (three), Haemophilus influenzae (two), and Serratia marce scens tone). Eight of these nine patients had a history of postobstructive infections, of which three were currently being treated with antibiotics. P our weeks following therapeutic bronchoscopy, airway colonization/infection was present in five of 20 (25%) patients, each of whom had airway coloniza tion/infection prior to bronchoscopy. In three of these five patients, the same organisms were found 4 weeks after bronchoscopy as at baseline broncho scopy. In two of five patients new organisms were identified: one case of S treptococcus viridans and one case of Haemophilus parainfluenzae, both cons idered to be nonpathogens. In four of nine patients with airway colonizatio n/infection prior to bronchoscopy, the airways were clear of micro-organism s after the procedure. The authors conclude that: 1) nonstenting therapeutic rigid bronchoscopy is not complicated by airway colonization or infection by new potential patho gens; and 2) therapeutic rigid bronchoscopy led to clearing of airway colon ization/infection in almost half of the patients studied.