Evaluation of early mini-bronchoalveolar lavage in the diagnosis of health care-associated pneumonia: a prospective study

Crit Care. 2013 Feb 5;17(1):R24. doi: 10.1186/cc12501.


Introduction: Health care-associated pneumonia (HCAP) has been proposed as a new category of respiratory infection to identify patients at risk of multidrug-resistant (MDR) pathogens. The American Thoracic Society's recommendation for HCAP treatment is to use broad-spectrum and multiple antibiotics. However, this strategy may be economically expensive and promote antimicrobial resistance when a multisensitive pathogen is not identified.

Methods: We prospectively included all patients presenting with HCAP in the emergency department. Blood cultures and fiberoptic bronchoscope-guided distal protected small volume bronchoalveolar lavage (FODP mini-BAL) were performed in each patient. Empirical antibiotic therapy was adapted when microbiological findings were available. The primary objective was to assess whether FODP mini-BAL is more efficient than blood cultures in identifying pathogens with the ratio of identification between both techniques as principal criteria.

Results: We included 54 patients with HCAP. Pathogens were identified in 46.3% of cases using mini-BAL and in 11.1% of cases using blood cultures (P <0.01). When the patient did not receive antibiotic therapy before the procedure, pathogens were identified in 72.6% of cases using mini-BAL and in 9.5% of cases using blood cultures (P <0.01). We noted multidrug-resistant pathogens in 16% of cases. All bronchoscopic procedures could be performed in patients without complications.

Conclusions: FODP mini-BAL was more efficient than blood cultures for identifying pathogens in patients presenting with HCAP. When bacteriological identification was obtained, antibiotic therapy was adapted in 100% of cases.See related letter by Sircar et al.,http://ccforum.com/content/17/2/428.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bronchoalveolar Lavage / instrumentation*
  • Bronchoalveolar Lavage / methods
  • Bronchoalveolar Lavage / standards*
  • Bronchoscopy / instrumentation
  • Bronchoscopy / methods
  • Bronchoscopy / standards
  • Cohort Studies
  • Cross Infection
  • Female
  • Fiber Optic Technology / instrumentation
  • Fiber Optic Technology / methods
  • Fiber Optic Technology / standards
  • Humans
  • Male
  • Middle Aged
  • Pneumonia, Bacterial / diagnosis*
  • Pneumonia, Bacterial / epidemiology
  • Pneumonia, Bacterial / therapy*
  • Prospective Studies