Chest
Volume 103, Issue 4, April 1993, Pages 1023-1027
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Clinical Investigations
Diagnostic Fiberoptic Bronchoscopy in Patients with Community-acquired Pneumonia: Comparison Between Bronchoalveolar Lavage and Telescoping Plugged Catheter Cultures

https://doi.org/10.1378/chest.103.4.1023Get rights and content

We compared the diagnostic value of quantitative cultures of bronchoalveolar lavage (BAL) and telescoping plugged catheter (TPC) samples in 40 patients with moderately severe community-acquired pneumonia (CAP). None had received antibiotics previously. BAL quantitative cultures were performed in 13 control patients without pneumonia. In 28 (70 percent) patients, TPC cultures yielded ≥103 cfu/ml of a pathogenic bacterium in pure culture. In 27 of these cases and in four additional cases, BAL cultures yielded ≥103 cfu/ml. BAL cultures from the control group were sterile in seven cases, yielded normal flora in three cases, and yielded microorganisms thought to be not significant in two cases. Microbiologic agreement was reached by both TPC and BAL for 32 (84 percent) of 38 microorganisms recovered. Quantitative cultures from both techniques correlated very well (r = 0.71, p<0.0001). We conclude that both TPC and BAL have similar accuracy to determine etiologic diagnosis of CAP. There was good qualitative and quantitative agreement between both techniques.

Section snippets

Patients

Forty patients (31 male), with a mean age of 42.5 ± 20.3 years, were studied. Seventeen were alcoholics, 14 were heavy smokers, and 8 patients had COPD. Other underlying diseases included three cases of diabetes mellitus, and one each of the following: chronic renal failure, asthma, breast cancer, rheumatoid arthritis, hepatic cirrhosis, and obstructive jaundice. The mean arterial oxygen partial pressure was 68.5 ± 18.2 mm Hg with a mean P(A-a)O2 of 41.4 ± 17.2 mm Hg. The white blood cell count

RESULTS

In 28 (70 percent) of 40 cases of CAP studied, a definite etiology was confirmed by microbiologic methods. Results are shown in Table 1. Altogether, 31 microorganisms were cultured in significant counts; S pneumoniae (75 percent) and Haemophilus influenzae (21 percent) were the most frequent agents found (both agents in two cases).

DISCUSSION

The results of this study demonstrate that quantitative BAL cultures are as reliable as TPC cultures in diagnosing etiology of CAP.

Few studies have examined the diagnostic value of bronchoscopic techniques in patients with CAP. Sörensen et al8 studied 36 patients with severe CAP and performed a very thorough diagnostic study that included bronchoscopy with TPC. Although bronchoscopic tests were performed in patients receiving antibiotics, the authors were able to establish an etiologic

ACKNOWLEDGMENT:

We are indebted to Dr. A. P. Cristoffanini for his invaluable help and criticism in reviewing the manuscript.

REFERENCES (21)

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Supported by a grant from Comisión Nacional de Investigación Científica y Tecnológica (Proyecto FONDECYT 043/89).

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