Chest
Volume 97, Issue 3, March 1990, Pages 576-582
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Clinical Investigations
Diagnostic Fiberoptic Bronchoscopy and Protected Brush Culture in Patients with Community-Acquired Pneumonia

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A model for performing fiberoptic bronchoscopy as a supplement to noninvasive diagnostic methods, in patients with community-acquired pneumonia, was prospectively studied. Twenty-four patients underwent bronchoscopy, seven pilot patients and 17 of 277 (6 percent) consecutive patients with CAP. Indications for FOB were early therapy failure (≤72h)(n = 7), late therapy failure (>72h)(n = 11), or before start of antibiotic therapy in severely ill or immunocompromised patients (n = 6). Samples were obtained by aspiration of bronchial secretion and with a protected brush catheter from which quantitative cultures with a detection level of 104 colony forming units per ml were performed. Results concluded that FOB, with the use of quantitative PB-cultures, offered a safe and specific diagnostic tool, which on special indications, can be of great value in the management of patients with CAP.

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MATERIALS AND METHODS

Patients with CAP treated in the Department for Infectious Diseases at Danderyd Hospital were included in the study.

Pilot study: to test the planned bronchoscopy procedure, seven CAP patients received bronchoscopy between October 1985 and December 1986.

Main study: during a ten-month period in 1987, all adult (≥18 years) patients (HIV patients excluded for technical reasons) hospitalized with clinical signs of a community-acquired lower respiratory tract infection and a pulmonary x-ray film

Demographic Data

The mean age of the 24 patients, 13 women and 11 men, undergoing bronchoscopy was 53 years (SD ± 16). Ten were smokers and one was a known alcoholic. Eight patients had a known pre-existing medical condition, and two of these were immunocompromised.

Patient Compliance and Complications

Consent was given by all patients to whom FOB was suggested because of therapy failure. Six of eight patients who were asked to participate in the study before antibiotic therapy was started agreed to bronchoscopy. No complications were seen during

DISCUSSION

In this prospective study, we tried to evaluate the usefulness of diagnostic FOB in patients with CAP

A significant decline in arterial oxygen pressure (PaO2) is common following FOB, with a subsequent risk of cardiac arrhythmia in particular.32 This could be especially hazardous in patients with pneumonia, in whom fever, tachycardia, and an already lowered PaO2 are common. However, by adding supplemental oxygen to patients at risk, no cardiac complications were seen in any of our patients, nor

ACKNOWLEDGMENTS

We are indebted to Dr. B. Wretlind and his staff at the Microbiological Laboratory, Danderyd Hospital, and to Mrs. B. Svensson, for their technical assistance in this study.

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    This study was supported in part by grants from Upjohn Pharmaceutical Company and the Swedisn Heart-Lung Foundation.

    Manuscript raoeived May 31; revision accepted August 25.

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