Bronchoscopy with bronchoalveolar lavage: determinants of yield and impact on management in immunosuppressed patients

Kottmann, R. Matthew; Kelly, Jennifer L.; Lyda, Elizabeth; Gurell, Michael; Stalica, Jennifer; Ormsby, Wayne; Moon, Karoline; Trawick, David R.; Sime, Patricia J.

doi:10.1136/thx.2010.145540

Cited by 28 publications

(29 citation statements)

References 5 publications

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“…We found that the quantitative BAL fluid bacterial culture yield was as low as 2.94% in patients with pneumonia who were already on antimicrobials. This yield is much lower than that of previous studies, which reported 30-80% culture rates [14-17], possibly due to use of antimicrobials before BAL. Preculture antimicrobials significantly decrease the yield of blood and sputum cultures [18-21].…”

Section: Discussioncontrasting

confidence: 67%

“…Furthermore, the long duration of antimicrobial treatment in our study (45% of patients received antimicrobials for more than 1 week before BAL) may have further decreased the yield. In a prior study, if BAL was performed within 3 days of starting antimicrobials, the overall yield was 63.4%, but decreased to 57.6% and 34.4% when performed within 3-14 days and after 14 days, respectively [14]. In addition, frequent use of wide-spectrum antimicrobials could decrease the yield of BAL fluid culture [22].…”

Section: Discussionmentioning

confidence: 99%

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Bacterial Yield from Quantitative Cultures of Bronchoalveolar Lavage Fluid in Patients with Pneumonia on Antimicrobial Therapy

Kim

Lee

et al. 2012

Korean J Intern Med

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Background/AimsEarly diagnosis and appropriate antimicrobial choice are crucial when managing pneumonia patients, and quantitative culture of bronchoalveolar lavage (BAL) fluid is considered a useful method for identifying pneumonia pathogens. We evaluated the quantitative yield of BAL fluid bacterial cultures in patients being treated with antimicrobials and attempted to identify factors predictive of positive BAL cultures.MethodsPatients over 18 years old and whose BAL fluid was subjected to quantitative culture to identify the organism causative of pneumonia between January 1, 2005, and December 31, 2009, were included. We reviewed the results of BAL fluid bacterial cultures and the clinical records, laboratory tests, and radiographic findings of the patients.ResultsBAL was performed on 340 patients with pneumonia. A positive BAL culture, defined as isolation of more than 104 colony forming units/mL bacteria, was documented in 18 (5.29%) patients. Of these, 9 bacteria isolated from 10 patients were classified as probable pathogens. The most frequently isolated bacteria were methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii, and Pseudomonas aeruginosa. No independent predictive factor for positive BAL cultures was identified.ConclusionsThe yield of quantitative BAL fluid bacterial culture in patients already on antimicrobials was low. Clinicians should be cautious when performing a BAL culture in patients with pneumonia who are already on antimicrobials.

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Bacterial Yield from Quantitative Cultures of Bronchoalveolar Lavage Fluid in Patients with Pneumonia on Antimicrobial Therapy

Kim

Lee

et al. 2012

Korean J Intern Med

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“…Culture-based approaches however often fail in detecting a causative agent. Prior antimicrobial therapy decreases the sensitivity of methods based on bacterial viability [9, 10], and certain pathogens are generally not cultivable with standard methods. In addition, these methods are time-consuming and labor-intensive.…”

Section: Introductionmentioning

confidence: 99%

Broad-Range Detection of Microorganisms Directly from Bronchoalveolar Lavage Specimens by PCR/Electrospray Ionization-Mass Spectrometry

et al. 2017

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The clinical demand on rapid microbiological diagnostic is constantly increasing. PCR coupled to electrospray ionization-mass spectrometry, PCR/ESI-MS, offers detection and identification of over 750 bacteria and Candida species directly from clinical specimens within 6 hours. In this study, we investigated the clinical performance of the IRIDICA BAC LRT Assay for detection of bacterial pathogens in 121 bronchoalveolar lavage (BAL) samples that were received consecutively at our bacterial laboratory for BAL culture. Commensal or pathogenic microorganisms were detected in 118/121 (98%) BAL samples by PCR/ESI-MS, while in 104/121 (86%) samples by routine culture (P<0.01). Detection of potentially pathogenic microorganisms by PCR/ESI-MS was evaluated in comparison with conventional culture-based or molecular methods. The agreement between positive findings was overall good. Most Staphylococcus aureus-positive PCR/ESI-MS results were confirmed by culture or species-specific PCR (27/33, 82%). The identity of Streptococcus pneumoniae could however be confirmed for only 6/17 (35%) PCR/ESI-MS-positive samples. Non-cultivable and fastidious pathogens, which were not covered by standard culture procedures were readily detected by PCR/ESI-MS, including Legionella pneumophila, Bordetella pertussis, Norcadia species and Mycoplasma pneumoniae. In conclusion, PCR/ESI-MS detected a broad range of potential pathogens with equal or superior sensitivity compared to conventional methods within few hours directly from BAL samples. This novel method might thus provide a relevant tool for diagnostics in critically ill patients.

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“…Flexible bronchoscopy with bronchoalveolar lavage (BAL) is an important tool utilized to diagnose pulmonary disease [1,2]. BAL has been reported to identify infection, malignancy, diffuse alveolar hemorrhage, or pulmonary alveolar proteinosis, in 65% of patients with mixed hematologic malignancy [3], between 35 and 55% of bone marrow transplant recipients [4,5], between 41 and 50% of heart and lung transplant recipients [6,7] and between 52 and 56% of patients with mixed immunosuppression [8][9][10]. The duration of symptoms, type and duration of immunosuppression, timing of bronchoscopy, use of prophylactic and empiric antimicrobial therapy, and the presence of endemic infections vary significantly across populations and likely impact reported yields.…”

Section: Introductionmentioning

confidence: 99%

The clinical impact of pneumocystis and viral PCR testing on bronchoalveolar lavage in immunosuppressed patients

Lachant

Croft

Minton

et al. 2018

Respiratory Medicine

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Introduction: Pulmonary infiltrates in immunosuppressed patients are common. Yields from bronchoscopy with bronchoalveolar lavage (BAL) has been reported to be between 31 and 65%. The clinical impact of pneumocystis and viral Polymerase chain reaction (PCR) testing on BAL has not been extensively evaluated in a mixed immunosuppressed patient population. Methods: We performed a retrospective chart review of immunosuppressed adults with pulmonary infiltrates who underwent BAL at the University of Rochester Medical Center. Only one BAL per patient was included. We compared the rate of positive PCR testing to conventional testing. We then investigated factors associated with positive PCR testing. Finally, we assessed for changes in antimicrobial therapy after bronchoscopy. Results: Three hundred and fifty-nine patients underwent BAL with 249 patients having pneumocystis PCR testing and 142 having viral PCR testing. Pneumocystis identification occurred in 43 patients and viral species identification occurred in 56 patients. PCR testing increased pneumocystis identification compared to microscopy, 14% vs. 5%, p = 0.01, and viral identification compared to culture, 25% vs. 6%, p = 0.0001. Of the patients with positive pneumocystis PCR testing 49% had antibiotics stopped, 66% were started on anti-pneumocystis therapy, and only 6% did not receive treatment. There was no difference in the number of patients with antibiotics stopped based on viral PCR testing results. Discussion: PCR testing increases BAL yield in immunosuppressed patients compared to conventional testing. Pneumocystis identified by PCR only may cause a self-limited infection and may not require antimicrobial therapy. PCR testing should be included in the evaluation of pulmonary infiltrates in immunosuppressed patients.

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Bronchoscopy with bronchoalveolar lavage: determinants of yield and impact on management in immunosuppressed patients

Cited by 28 publications

References 5 publications

Bacterial Yield from Quantitative Cultures of Bronchoalveolar Lavage Fluid in Patients with Pneumonia on Antimicrobial Therapy

Bacterial Yield from Quantitative Cultures of Bronchoalveolar Lavage Fluid in Patients with Pneumonia on Antimicrobial Therapy

Broad-Range Detection of Microorganisms Directly from Bronchoalveolar Lavage Specimens by PCR/Electrospray Ionization-Mass Spectrometry

The clinical impact of pneumocystis and viral PCR testing on bronchoalveolar lavage in immunosuppressed patients

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