INVASIVE DIAGNOSTIC TECHNIQUES FOR PNEUMONIA: PROTECTED SPECIMEN BRUSH, BRONCHOALVEOLAR LAVAGE, AND LUNG BIOPSY METHODS - 09/09/11
Résumé |
The identification of pneumonia, whether community-, nosocomial-, or ventilator-acquired, is still a difficult problem. In the community setting, the presence of new chest infiltrates, fever, leukocytosis, and purulent secretions usually reflect the presence of an underlying pulmonary infection.8, 15, 17 However, in the hospital setting, this is not always true. Several conditions, particularly in mechanically ventilated patients, can cause chest infiltrates and fever and can mimic pneumonia. The identification of the cause of pulmonary infections is still more complex. Variations in the clinical presentation warrant bacteriologic confirmation to direct the initial antimicrobial therapy, particularly in the hospital setting or for immunocompromised hosts. It has been estimated that as many as 15% of all deaths occurring in hospitalized patients are directly related to pneumonia. Recently several studies have shown that one third of all deaths occurring in nosocomial pneumonia patients are directly attributable to pneumonia.24, 25, 45 Other studies have shown that inadequate initial antibiotic treatment is related to prognosis.8 In addition, overtreatment with antibiotics may lead to infections with more virulent microorganisms such as Pseudomonas aeruginosa or Acinetobacter calcoaceticus.79 It seems obvious that early detection of pneumonia and the obtaining of a microbiologic diagnosis are important goals when facing this frequent infection. Unfortunately, these goals are still difficult to achieve, since many patients have received prior antibiotics before sampling, and the inherent imperfections of sampling methods with regard to sensitivity and specificity make the identification of the causal microbial agents more difficult.57 Microbiologic diagnosis of nosocomial pneumonia may also be a problem, since the oropharyngeal cavity of hospitalized patients is commonly colonized by potential pulmonary pathogens. This can lead to misinterpretation of respiratory samples that do not by-pass the oropharynx. During the last decade, several investigators have reported results about diagnosis of pneumonia using techniques that try to avoid oropharyngeal colonization. These techniques, also called invasive, have become very popular, especially in Europe, for diagnosing hospital-acquired pneumonia and particularly ventilator-associated pneumonia. More severely ill patients or patients not responding to initial empiric antibiotic regimens may potentially benefit from these techniques.
This article reviews various techniques (protected specimen brush (PSB), bronchoalveolar lavage (BAL), and lung biopsy) and their potential risks and benefits in the diagnosis of lower respiratory tract infection.
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| Address reprint requests to Antoni Torres, MD, Servei de Pneumologia, Hospital Clinic, Villarroel 170.08036 Spain This work was supported by grant CIRIT/Fundació Clínic (Comissió Interdepartamental per a la Recerca i Tecnologia), and by grant I + D 96/0024 |
Vol 12 - N° 3
P. 701-722 - septembre 1998 Retour au numéro
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- VALUE OF NONINVASIVE STUDIES IN COMMUNITY-ACQUIRED PNEUMONIA
- Joseph F. Plouffe, Cora McNally, Thomas M. File
- COMMUNITY-ACQUIRED PNEUMONIA: EPIDEMIOLOGY, ETIOLOGY, TREATMENT
- Thomas J. Marrie
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