• 26
    Apr
  • Diagnostic Fiberoptic Bronchoscopy and Protected Brush Culture: RESULTS

Diagnostic Fiberoptic Bronchoscopy and Protected Brush Culture: RESULTS

Demographic Data The mean age of the 24 patients, 13 women and 11 men, undergoing bronchoscopy was 53 years (SD ± 16). Ten were smokers and one was a known alcoholic. Eight patients had a known pre-existing medical condition, and two of these were immunocom­promised.

Patient Compliance and Complications

Consent was given by all patients to whom FOВ was suggested because of therapy failure. Six of eight patients who were asked to participate in the study before antibiotic therapy was started agreed to bron­choscopy. No complications were seen during or after bronchoscopy in any of the 24 patients.

Etiology

An etiologic diagnosis was obtained in 19 of 24 patients (79 percent) (Table 1). Bacterial pneumonia was diagnosed in 17 patients, in eight cases caused by S pneumoniae. In one patient, a viral etiology only could be demonstrated and in another, a bronchial tumor was diagnosed. The etiologic diagnosis was obtained by FOB in 13 of the 24 (54 percent) patients, and in one half of them by bronchoscopy only.
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Table 1 —Etiologic Diagnosis and Diagnostic Method in 24 Batients Having Bronchoscopy Due to CAP

Diagnostic Method

Bronchoscopy Noninvasive*

Etiologic Agent

No.

Only

Only

Both

S
pneumoniae

8

1

3

4

M pneumoniae
(MP)

2

2

Branhamella
catarrhalis

1

1

Legionella sp

2

Anaerobic Gram

positive coccit

1

1

a Hemolytic

streptococci!

1

1

M pneumoniae
+

Streptococcus
mitis

1

У4

У4

Mycobacteria

tuberculosis

1

1

Adenovirus

1

1

None (pulmonary

tumor)

1

1

Unknown

5

Total

24

6Уа

6

Bronchoscopy Because of Early Therapy Failure

During the study period, 18/277 (6.5 percent) patients met the criteria for early therapy failure. Thirteen of these were excluded because of suspected M pneumoniae pneumonia in seven patients (later confirmed by serology in six patients), pregnancy in one, high age in two, and technical problems in three. The results for the remaining five patients, together with two patients from the pilot study with early therapy failure, are presented in Table 2. None of the patients had a positive PB culture, but examination of bronchial secretion resulted in an etiologic diagnosis in two patients, one (No. 3) with tuberculosis (positive smear and culture) and one (No. 7) with a Legionella infection (positive culture), in four patients, (No. 1, 4, 5, 6), the result of the PB culture was considered as true negative. In the last patient (No. 2), the PB culture may have been falsely negative since the patient recovered only after a change of antibiotic therapy.

Table 2—Result of Diagnostic Bronchoscopy with the PB catheter tn Batients with CAP in the Early 72h) Failure Group

Case No.

Sex Age

Delay (d)t

AB$

Results of the PB Culture Usefulness§

Final Diagnosis

1

M

51

8

PcG

Negative

Tn

MHI

2

F

66

3

PcV

Negative

Fn?

Nonet

3

M

81

16

PcG

Negative

Tn

Tuberculosis

4

F

64

7

PcG

Negative

Tn

None**

5

M

59

6

T+S Negative

Tn

Nonett

Ery

6*

M

20

10

PcG

Negative

Tn

MP||

7*

F

45

6

Ery

Not done

Legionella^

Rif

Bronchoscopy Because of Late Therapy Failure

Therapy failure after >72 hours of antibiotic treat­ment was seen in 19 of 277 (7 percent) patients during the main study. Of these, bronchoscopy was contra- indicated in three, an etiologic diagnosis was reached by other means in two, a mycoplasmal infection was suspected in four (all later verified by serology), and in three patients, therapy had been changed before bronchoscopy could be performed. Seven patients underwent bronchoscopy (table 3). In four patients with pneumococcal pneumonia (No. 8,11,17,18), no other organism could be demonstrated. In one of the four patients (No. 8), pneumococcal antigen was demonstrated on the PB, and in another one (No. 18), growth of S pneumoniae was found in bronchial secretion but not on the PB. canada drugs online

Table 3—Result of Diagnostic Bronchoscopy with PB Catheter in Patients with CAP in Late (>72h) Failure Group

Case No.

Sex

Age

Delay (d)t

Initial Diagnosis/Method

AB$

Results of the PB Culture Usefulness!

Final Diagnosis

8

F

38

5

S pneumoniae/blood culture

Cef

Negative||

Sec.

S
pneumoniae

9

M

55

17

None

PcG

Negative

Tn

None

10

F

44

10

None

PcV

Negative

Fn?1

S pneumoniae
(?)

11

M

42

12

S pneumoniae/CoA/sputum

PcG

Negative

Tn

S pneumoniae

12

M

63

12

None

PcG

Negative

Tn

None

13

F

59

15

None

Ery

Negative

Tn

Adenovirus

14

F

41

6

None

PcG

S mitis lOVml

Prim

MP**
+

S mitis

15*

M

15

6

None

Dox

a-streptococci 107ml

Prim

See PB

16*

M

70

10

None

Cef

Negative

Tn

Legionellaft

17*

M

64

6

S pneumoniae/sputum culture

Cef

Negative

Tn

S pneumoniae

18*

F

55

12

S pneumoniae/blood culture

Cef

Negative

Тn++

S pneumoniae

In the remaining seven patients, no etiologic agent had been found before bronchoscopy was performed. The PB cultures from two patients were positive; with Streptococcus mitis lOVml in one (No. 14), who had also a Mycoplasma infection, and with a-hemolytic streptococci (not typed) lOVml in another one (No. 15), a young man who had a preceding episode of aspiration. In four patients, the PB culture was consid­ered as true negative. In the last patient (No. 10), capsular-CoA was positive on sputum samples after bronchoscopy, indicating that the result of the PB examination may have been false negative.

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