Summary
In 29 patients with community-acquired pneumonia, 24 patients with hospital-acquired pneumonia and 35 patients with pneumonia in the immunocompromised host the diagnostic value of bronchoalveolar lavage (BAL) with quantitative bacterial and fungal cultures was studied; 32 patients with noninfectious pulmonary diseases and 14 healthy volunteers served as controls. An infectious etiology could be established in 81% of the pneumonia patients without differences between the three groups; significant infection was associated with colony counts of ≥ 104 cfu/ml. Prior antibiotic therapy lowered the yield of BAL culture only in community-acquired pneumonia (94%vs 55% positive cultures in untreatedvs pretreated patients, p<0.02). Furthermore the culture results were related to the radiographic extension of pulmonary infiltrates (92% positive cultures in multilobarvs 54% in lobar or segmental infiltrates, p<0.001). Therapeutic consequences of BAL were shown by resistance of the isolated organisms to predefined empiric treatment regimens in 41% community-acquired pneumonia, 43% pneumonia in the immunocompromised host and 67% hospital-acquired pneumonia patients.
Zusammenfassung
Bei 29 Patienten mit ambulant erworbener Pneumonie, 24 Patienten mit hospital-erworbener Pneumonie und 35 Patienten mit Pneumonie unter Immunsuppression wurde der diagnostische Wert der bronchoalveolären Lavage mit quantitativem Erregernachweis untersucht; 32 Patienten mit nichtinfektiösen Lungenerkrankungen und 14 gesunde Probanden dienten als Kontrollen. Die Diagnose konnte in 81% der Pneumoniepatienten gesichert werden, ohne signifikante Unterschiede zwischen den Gruppen. Eine manifeste Infektion war mit Keimzahlen ≥ 104 cfu/ml korreliert. Eine vorausgegangene antibiotische Therapie verminderte die Ausbeute der Lavagekultur nur bei ambulant erworbener Pneumonie (94%vs. 55% positive Kulturen in unbehandeltenvs. vorbehandelten Patienten, p<0,02). Darüber hinaus waren die Kulturergebnisse von der röntgenologischen Ausdehnung der Infiltrate abhängig (92% positive Kulturen bei lappenübergreifendenvs. 54% bei lappen- oder segmentbegrenzten Infiltraten, p<0,001). Therapeutische Konsequenzen der BAL ergaben sich durch Resistenz der kultivierten Erreger gegenüber der vorab definierten empirischen Chemotherapie in 41% (ambulant erworben) bzw. 43% (Immunsuppression) und 67% (hospitalerworbene Pneumonie).
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Dalhoff, K., Braun, J., Lipp, R. et al. Diagnostic value of bronchoalveolar lavage in patients with opportunistic and nonopportunistic bacterial pneumonia. Infection 21, 291–296 (1993). https://doi.org/10.1007/BF01712447
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DOI: https://doi.org/10.1007/BF01712447