Skip to main content
PMC home page
Thorax logoLink to Thorax
. 2001 Feb;56(2):115–120. doi: 10.1136/thorax.56.2.115

Role of bronchoalveolar lavage in immunocompromised patients with pneumonia treated with a broad spectrum antibiotic and antifungal regimen

I Hohenadel 1, M Kiworr 1, R Genitsariotis 1, D Zeidler 1, J Lorenz 1
PMCID: PMC1745998  PMID: 11209099

Abstract

BACKGROUND—In a retrospective study the value of bronchoalveolar lavage (BAL) in the diagnosis of pneumonia was investigated in 95 immunocompromised patients suffering from haematological disorders and receiving a regimen of broad spectrum antibiotics and antifungal agents (BSAR).
METHODS—With the exception of four afebrile patients, all had fever, raised C reactive protein (CRP) levels, and new infiltrates visible on chest radiography. All patients underwent BAL to identify the organism causing the pneumonia and surveillance cultures were performed regularly for pathogens at different sites. Following classification of the isolates, patients with positive cultures were subdivided into two groups, pathogenic or contaminated. We investigated whether relevant pathogens were cultured only from the BAL fluid and whether they were susceptible to BSAR.
RESULTS—Although 77 of the 95 patients were thrombocytopenic, bleeding during BAL occurred in only 15% of all patients. Ten days after the procedure the fever improved in 88% of patients, radiographic findings improved in 71%, and CRP levels improved in 75% of patients; 22% of patients died within 28 days. Pathologically relevant isolates were found in 65% of all patients. Respiratory pathogens were detected only in the BAL fluid of 29 of the 95 patients (35% Gram positive species, 40% Gram negative species, 11% Mycobacterium, 11% fungi, and 3% cytomegalovirus). In 16 of these 29 patients (55%) the pathogens cultured only from the BAL fluid were resistant to treatment. Pathogens detected only in the BAL fluid were not susceptible to a standard broad spectrum antibiotic and antifungal regimen including teicoplanin, ceftriaxon, tobramycin, and amphotericin B in 12 of the 29 patients (41%).
CONCLUSIONS—Our data suggest that 12 patients were treated with broad spectrum antimicrobial agents which were not directed at the appropriate organism on in vitro sensitivity tests without BAL. BAL is a relatively safe procedure in the diagnosis of pneumonia, supplying important information in immunocompromised patients as well as in immunocompromised patients receiving BSAR.



Full Text

The Full Text of this article is available as a PDF (128.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Chopra S. K., Mohsenifar Z. Fiberoptic bronchoscopy in diagnosis of opportunistic lung infections: assessment of Sputa, Washings, Brushings and biopsy specimens. West J Med. 1979 Jul;131(1):4–7. [PMC free article] [PubMed] [Google Scholar]
  2. Christensen G. D., Bisno A. L., Parisi J. T., McLaughlin B., Hester M. G., Luther R. W. Nosocomial septicemia due to multiply antibiotic-resistant Staphylococcus epidermidis. Ann Intern Med. 1982 Jan;96(1):1–10. doi: 10.7326/0003-4819-96-1-1. [DOI] [PubMed] [Google Scholar]
  3. Cordonnier C., Bernaudin J. F., Fleury J., Feuilhade M., Haioun C., Payen D., Huet Y., Atassi K., Vernant J. P. Diagnostic yield of bronchoalveolar lavage in pneumonitis occurring after allogeneic bone marrow transplantation. Am Rev Respir Dis. 1985 Nov;132(5):1118–1123. doi: 10.1164/arrd.1985.132.5.1118. [DOI] [PubMed] [Google Scholar]
  4. Dalhoff K., Braun J., Hollandt H., Lipp R., Wiessmann K. J., Marre R. Diagnostic value of bronchoalveolar lavage in patients with opportunistic and nonopportunistic bacterial pneumonia. Infection. 1993 Sep-Oct;21(5):291–296. doi: 10.1007/BF01712447. [DOI] [PubMed] [Google Scholar]
  5. Hunninghake G. W., Gadek J. E., Kawanami O., Ferrans V. J., Crystal R. G. Inflammatory and immune processes in the human lung in health and disease: evaluation by bronchoalveolar lavage. Am J Pathol. 1979 Oct;97(1):149–206. [PMC free article] [PubMed] [Google Scholar]
  6. Jones R. N. Impact of changing pathogens and antimicrobial susceptibility patterns in the treatment of serious infections in hospitalized patients. Am J Med. 1996 Jun 24;100(6A):3S–12S. doi: 10.1016/s0002-9343(96)00102-7. [DOI] [PubMed] [Google Scholar]
  7. Kahn F. W., Jones J. M. Analysis of bronchoalveolar lavage specimens from immunocompromised patients with a protocol applicable in the microbiology laboratory. J Clin Microbiol. 1988 Jun;26(6):1150–1155. doi: 10.1128/jcm.26.6.1150-1155.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Kahn F. W., Jones J. M., England D. M. The role of bronchoalveolar lavage in the diagnosis of invasive pulmonary aspergillosis. Am J Clin Pathol. 1986 Oct;86(4):518–523. doi: 10.1093/ajcp/86.4.518. [DOI] [PubMed] [Google Scholar]
  9. Lerner C. W., Tapper M. L. Opportunistic infection complicating acquired immune deficiency syndrome. Clinical features of 25 cases. Medicine (Baltimore) 1984 May;63(3):155–164. doi: 10.1097/00005792-198405000-00002. [DOI] [PubMed] [Google Scholar]
  10. Marra R., Pajano L., Pagliari G., Frigiera L., Storti S., Morace G., Ardito F., Leone G. The yield of bronchoalveolar lavage in the etiological diagnosis of pneumonia in leukemia and lymphoma patients. Eur J Haematol. 1993 Oct;51(4):256–258. doi: 10.1111/j.1600-0609.1993.tb00641.x. [DOI] [PubMed] [Google Scholar]
  11. Martin W. J., 2nd, Smith T. F., Sanderson D. R., Brutinel W. M., Cockerill F. R., 3rd, Douglas W. W. Role of bronchoalveolar lavage in the assessment of opportunistic pulmonary infections: utility and complications. Mayo Clin Proc. 1987 Jul;62(7):549–557. doi: 10.1016/s0025-6196(12)62292-7. [DOI] [PubMed] [Google Scholar]
  12. Maschmeyer G., Link H., Hiddemann W., Meyer P., Helmerking M., Eisenmann E., Schmitt J., Adam D. Empirische antimikrobielle Therapie bei neutropenischen Patienten. Ergebnisse einer multizentrischen Studie der Arbeitsgruppe Infektionen in der Hämatologie der Paul-Ehrlich-Gesellschaft. Med Klin (Munich) 1994 Mar 15;89(3):114–123. [PubMed] [Google Scholar]
  13. Maschmeyer G., Link H., Hiddemann W., Meyer P., Helmerking M., Eisenmann E., Schmitt J., Adam D. Pulmonary infiltrations in febrile patients with neutropenia. Risk factors and outcome under empirical antimicrobial therapy in a randomized multicenter study. Cancer. 1994 May 1;73(9):2296–2304. doi: 10.1002/1097-0142(19940501)73:9<2296::aid-cncr2820730910>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  14. Ostergaard L., Andersen P. L. Etiology of community-acquired pneumonia. Evaluation by transtracheal aspiration, blood culture, or serology. Chest. 1993 Nov;104(5):1400–1407. doi: 10.1378/chest.104.5.1400. [DOI] [PubMed] [Google Scholar]
  15. Reynolds H. Y. Bronchoalveolar lavage. Am Rev Respir Dis. 1987 Jan;135(1):250–263. doi: 10.1164/arrd.1987.135.1.250. [DOI] [PubMed] [Google Scholar]
  16. Rosenow E. C., 3rd, Wilson W. R., Cockerill F. R., 3rd Pulmonary disease in the immunocompromised host. 1. Mayo Clin Proc. 1985 Jul;60(7):473–487. doi: 10.1016/s0025-6196(12)60872-6. [DOI] [PubMed] [Google Scholar]
  17. Rubio M., Palau L., Vivas J. R., del Potro E., Diaz-Mediavilla J., Alvarez A., Martinez R., Picazo J. J. Predominance of gram-positive microorganisms as a cause of septicemia in patients with hematological malignancies. Infect Control Hosp Epidemiol. 1994 Feb;15(2):101–104. doi: 10.1086/646869. [DOI] [PubMed] [Google Scholar]
  18. Saito H., Anaissie E. J., Morice R. C., Dekmezian R., Bodey G. P. Bronchoalveolar lavage in the diagnosis of pulmonary infiltrates in patients with acute leukemia. Chest. 1988 Oct;94(4):745–749. doi: 10.1378/chest.94.4.745. [DOI] [PubMed] [Google Scholar]
  19. Stover D. E., Zaman M. B., Hajdu S. I., Lange M., Gold J., Armstrong D. Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host. Ann Intern Med. 1984 Jul;101(1):1–7. doi: 10.7326/0003-4819-101-1-1. [DOI] [PubMed] [Google Scholar]
  20. Tenholder M. F., Moser R. J., 3rd, Tellis C. J. Mycobacteria other than tuberculosis. Pulmonary involvement in patients with acquired immunodeficiency syndrome. Arch Intern Med. 1988 Apr;148(4):953–955. doi: 10.1001/archinte.148.4.953. [DOI] [PubMed] [Google Scholar]
  21. Vincent J. L., Bihari D. J., Suter P. M., Bruining H. A., White J., Nicolas-Chanoin M. H., Wolff M., Spencer R. C., Hemmer M. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA. 1995 Aug 23;274(8):639–644. [PubMed] [Google Scholar]
  22. Young J. A., Hopkin J. M., Cuthbertson W. P. Pulmonary infiltrates in immunocompromised patients: diagnosis by cytological examination of bronchoalveolar lavage fluid. J Clin Pathol. 1984 Apr;37(4):390–397. doi: 10.1136/jcp.37.4.390. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Yu V. L., Muder R. R., Poorsattar A. Significance of isolation of Aspergillus from the respiratory tract in diagnosis of invasive pulmonary aspergillosis. Results from a three-year prospective study. Am J Med. 1986 Aug;81(2):249–254. doi: 10.1016/0002-9343(86)90259-7. [DOI] [PubMed] [Google Scholar]
  24. Zavala D. C. Pulmonary hemorrhage in fiberoptic transbronchial biopsy. Chest. 1976 Nov;70(5):584–588. doi: 10.1378/chest.70.5.584. [DOI] [PubMed] [Google Scholar]
  25. von Eiff M., Steimann R., Roos N., van Husen N., Walger P., Baumgart P., Fegeler W., Junge E., Baumeister H., Wilms B. Pneumonien bei abwehrgeschwächten Patienten: Stellenwert nicht bioptischer bronchoskopischer Untersuchungsverfahren in der Erregerdiagnostik. Klin Wochenschr. 1990 Apr 2;68(7):372–379. doi: 10.1007/BF01650887. [DOI] [PubMed] [Google Scholar]
  26. von Eiff M., Zühlsdorf M., Roos N., Thomas M., Büchner T., van de Loo J. Pulmonary infiltrates in patients with haematologic malignancies: clinical usefulness of non-invasive bronchoscopic procedures. Eur J Haematol. 1995 Mar;54(3):157–162. doi: 10.1111/j.1600-0609.1995.tb00207.x. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES