Bronchoalveolar Lavage for Diagnosing Acute Bacterial Pneumonia

Abstract

The utility of gram stain and semiquantitative culture of the fluid retrieved by bronchoalveolar lavage (BAL) in identifying the causative agent in acute bacterial pneumonia was initially assessed in 92 patients. Fifteen of these patients presented with clinically active bacterial pneumonia; the remaining patients underwent bronchoscopy to evaluate other processes in the lung. Thirteen of the 15 patients with clinically active bacterial pneumonia had a BAL culture greater than or equal to 10(5) colony-forming units per milliliter of BAL fluid, whereas none of the other groups had a positive culture (chi 2 = 70.7, P less than .001). Gram stain of cytocentrifuged BAL fluid was positive (one or more organisms seen per 1,000 X field) only in those patients with an active bacterial pneumonia. Applying this technique, we studied 59 immunocompromised patients presenting with pulmonary infiltrates. Eight (21%) of the 39 patients presenting with microbial-related infiltrates proved to have acute bacterial pneumonia by BAL culture; the pneumonia resolved with appropriate antimicrobial therapy.

Ventilator associated pneumonia: quality of nonbronchoscopic bronchoalveolar lavage sample affects diagnostic yield

“…The use of >10,000 cfu . mL -1 as the criteria for significant pathogens has proved to be a useful cut-off between pneumonia and not pneumonia in other studies [10,16] and represents the recommended cut-off for bronchoscopic BAL [11]. It has also been verified for nonbronchoscopic BAL [12,17].…”

“…They were asked to fill in a form for each nonbronchoscopic BAL with the volume instilled and returned. Aliquots were to be sent for semiquantitative culture [10]. Another aliquot was sent for cell count and cytocentrifuge prepared slides.…”

“…Invasive diagnostic procedures include protected brush specimens (PBS) and bronchoalveolar lavage (BAL). These techniques require use of semiquantitative cultures [10,11], and allow for the measurement of bacterial infectious load as well as proving to be fairly specific in diagnozing lower respiratory infection. Unfortunately, however, the yield is low.…”

Monotherapy in serious hospital-acquired infections: a clinical trial of ceftazidime versus imipenem/cilastatin

“…Of course, bacteriological diagnosis can be improved by the use of a fibre-optic bronchoscope with either broncho-alveolar lavage or the use of the protected specimen brush (Thorpe et al, 1987;Faling, 1988;Fagon et al, 1988). Quantitative culture will enhance the specificity of both methods, and it seems appropriate to recommend the use of these techniques for future studies in this population of patients.…”

Bronchoscopic and Nonbronchoscopic Methods of Airway Culturing in Tracheostomized Children

“…Bronchoscopic bronchoalveolar lavage (B-BAL) bacterial cultures have a widely accepted diagnostic accuracy in the evaluation of patients with a variety of respiratory disorders. 4,5 B-BAL culture results may, however, be affected by contamination of the inner channel of the bronchoscope from upper airway secretions. 6 The blind protected BAL (BP-BAL) method has the potential of obtaining noncontaminated samples of lower respiratory tract secretions.…”