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

Content Provider	Springer Nature : BioMed Central
Author	Lacroix, Guillaume Prunet, Bertrand Bordes, Julien Cabon-Asencio, Nathalie Asencio, Yves Gaillard, Tiphaine Pons, Sandrine D'aranda, Erwan Kerebel, Delphine Meaudre, Eric Goutorbe, Philippe
Abstract	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
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/cc12501.pdf
Ending Page	8
Page Count	8
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/cc12501
Journal	Critical Care
Issue Number	1
Volume Number	17
Language	English
Publisher	BioMed Central
Publisher Date	2013-02-05
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine Blood Culture Antibiotic Therapy Continuous Positive Airway Pressure Chronic Obstructive Pulmonary Disease Patient Empirical Antibiotic Therapy
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

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