Abstract
Early diagnosis and treatment of infections is the mainstay of management of lung disease in adult cystic fibrosis, particularly in those with Pseudomonas Aeruginosa. Treatment is guided by sputum culture results in the majority of cases. While bronchoalveolar lavage (BAL) is an alternative diagnostic tool, evidence for its clinical benefit is lacking. Our aim was to determine if bronchoalveolar lavage altered antimicrobial therapy in the management of lung infections in adults with cystic fibrosis.
We performed a retrospective audit of BAL done on adult cystic fibrosis patients during acute infective exacerbations. Sputum was obtained during the same exacerbation for culture. Results from BAL and sputum were compared to establish if there were differences in the microbiome profile and if this altered the existing antimicrobial therapy.
39 patients underwent bronchoscopy for BAL over a period of 6 years (15 F, 24 M). Mean FEV1was 1.84L (range 0.42L-3.95L). Treatment was altered in 4 patients (10.2%) as a result of BAL culture findings. Pseudomonas Aeruginosa was the most common pathogen cultured from both sputum and BAL (66% of all samples).
BAL did not alter treatment in 90% of patients during infective exacerbation of cystic fibrosis.As BAL resulted in a change of therapy for only a minority of CF patients, further work is required to identify CF patients that will benefit from BAL.
- Copyright ©ERS 2015
