Using Bronchoalveolar Lavage to Distinguish Nosocomial Pneumonia from Systemic Inflammatory Response Syndrome

Abstract

SIRS, which can mimic PN, is common in trauma patients. These entities can be distinguished by bronchoscopy with BAL. Basing antibiotic therapy solely on quantitative BAL cultures is efficacious in trauma patients.

Risk Factors for Late‐Onset Nosocomial Pneumonia Caused byStenotrophomonas maltophiliain Critically Ill Trauma Patients

“…Patients were excluded if they stayed in another hospital 12 days before admission to the ICU or if they had been transferred from the ICU to another hospital's ICU within 2 weeks of admission to the ICU at the Presley Memorial Trauma Center. Pneumonia was defined by a result of a quantitative bacterial bronchoalveolar lavage (BAL) culture of у10 5 cfu/mL, the appearance of a new or changing infiltrate on chest radiograph, and at least 2 of the following clinical signs of pneumonia: abnormal temperature (у38ЊC or !35.5ЊC), abnormal WBC count (у10,000 cells/mm 3 or р4000 cells/mm 3 or the presence of у10% immature bands), or macroscopically purulent sputum [16].…”

Methicillin-ResistantStaphylococcus aureusin Early Ventilator-Associated Pneumonia: Cause for Concern?

“…Ventilator-associated pneumonia was suspected if a patient had been mechanically ventilated ‡ 48 h; evidence existed of new or changing infiltrate on chest radiograph; and met at least two other criteria: 1) temperature > 38°C or < 36°C; 2) white blood cell count ( > 10,000 cells/mm 3 , < 4,000 cells/ mm 3 , or 10% immature bands); or 3) macroscopically purulent sputum [16,17]. Patients with suspected VAP underwent bronchoscopy in a uniform manner with bronchoalveolar lavage (BAL) as described previously [9,[17][18][19].…”

Changes in Pulmonary Cytokines during Antibiotic Therapy for Ventilator-Associated Pneumonia

“…Although pulmonary cytokine concentration is increased at the time of VAP diagnosis [4,[17][18][19], this is the first report of the potential of these markers to indicate patient response to antibiotic therapy. These results are strengthened by the use of quantitative BAL culture results that identify the presence of VAP more accurately [1,[9][10][11].…”

“…Microbiologic responders had repeat BAL samples wherein all bacteria demonstrated growth <10,000 cfu=mL, whereas microbiologic non-responders had persistent growth of !10,000 cfu=mL of the original pathogen [16]. A new VAP episode was diagnosed if a different pathogen demonstrated !100,000 cfu=mL on repeat BAL [8][9][10][11].…”

“…[8][9][10][11]; (2) were !18 years of age; and (3) had a repeat BAL performed after three days of adequate antibiotic therapy. Patients were excluded if they had (1) active malignant disease; (2) a leukocyte count <4,000=mcL; (3) chronic use of immunosuppressive medications; (4) acute respiratory distress syndrome [12]; (5) concurrent meningitis; (6) concurrent intra-abdominal infection; or (7) transfer from another hospital !48 h after injury.…”