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

Abstract

Absence of bacterial colonization of the airways after therapeutic rigid bronchoscopy without stenting. M. Noppen, D. Pie Ârard, M. Meysman, R.V. Herreweghe, W. Vincken. #ERS Journals Ltd 2000. ABSTRACT: Following airway stenting, bacterial colonization of the airways with potentially 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 culture were performed immediately prior to, and 4 weeks after nonstenting therapeutic rigid bronchoscopy in 20 consecutive patients with central airway lesions.Prior to therapeutic bronchoscopy, airway colonization/infection was present in nine of 20 (45%) patients. In these nine patients, 10 different potential pathogens were identified: Streptococcus pneumoniae (four cases), Pseudomonas aeruginosa (three), Haemophilus influenzae (two), and Serratia marcescens (one). Eight of these nine patients had a history of postobstructive infections, of which three were currently being treated with antibiotics. Four weeks following therapeutic bronchoscopy, airway colonization/infection was present in five of 20 (25%) patients, each of whom had airway colonization/infection prior to bronchoscopy. In three of these five patients, the same organisms were found 4 weeks after bronchoscopy as at baseline bronchoscopy. In two of five patients new organisms were identified: one case of Streptococcus viridans and one case of Haemophilus parainfluenzae, both considered to be nonpathogens. In four of nine patients with airway colonization/infection prior to bronchoscopy, the airways were clear of micro-organisms after the procedure.The authors conclude that: 1) nonstenting therapeutic rigid bronchoscopy is not complicated by airway colonization or infection by new potential pathogens; and 2) therapeutic rigid bronchoscopy led to clearing of airway colonization/infection in almost half of the patients studied. Although rigid bronchoscopy is performed less often than flexible bronchoscopy in adult pulmonary medicine, it is preferred for therapeutic intervention in the central airways, including laser treatment, cryotherapy, dilatation procedures, mechanical debridement and stenting [1].The authors recently showed that following airway stenting, bacterial colonization of the airways with potentially pathogenic micro-organisms (PPM's) occurs within 3±4 weeks of the procedure in the majority of treated patients.The mechanism of this airway colonization after stenting remains unclear. One possible explanation is contamination of the airways via the rigid bronchoscope itself, by translocation of bacteria that may already colonize the oropharynx and/or proximal airway [2].In order to confirm or refute this hypothesis, the authors performed quantitative protected specimen b...

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“…It is feasible that the mechanical introduction of the bronchoscope into the airway may potentially facilitate transfer of microorganisms from upper respiratory tract into the distal airways. Mixed reports from previous studies suggest limited association between bronchoscopy and subsequent colonization of the lower respiratory tract . Our study demonstrates in control patients who have undergone bronchoscopy alone, without stent insertion only 25% of patients were colonized.…”