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Open Access Highly Accessed Research

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

Guillaume Lacroix1*, Bertrand Prunet1, Julien Bordes1, Nathalie Cabon-Asencio2, Yves Asencio1, Tiphaine Gaillard3, Sandrine Pons3, Erwan D'aranda1, Delphine Kerebel1, Eric Meaudre1 and Philippe Goutorbe1

Author Affiliations

1 Department of Anesthesiology and Intensive Care, Sainte Anne Military Teaching Hospital, Boulevard Sainte Anne, BP 20545, 83041 Cedex 09 Toulon France

2 Medical Records Department, Sainte Anne Military Teaching Hospital, Boulevard Sainte Anne, BP 20545, 83041 Cedex 09 Toulon France

3 Bacteriological laboratory federation, Sainte Anne Military Teaching Hospital, Boulevard Sainte Anne, BP 20545, 83041 Cedex 09 Toulon France

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Critical Care 2013, 17:R24  doi:10.1186/cc12501

Published: 5 February 2013

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 webcite