Title |
Evaluation of early mini-bronchoalveolar lavage in the diagnosis of health care-associated pneumonia: a prospective study
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Published in |
Critical Care, February 2013
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DOI | 10.1186/cc12501 |
Pubmed ID | |
Authors |
Guillaume Lacroix, Bertrand Prunet, Julien Bordes, Nathalie Cabon-Asencio, Yves Asencio, Tiphaine Gaillard, Sandrine Pons, Erwan D'aranda, Delphine Kerebel, Eric Meaudre, Philippe Goutorbe |
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. |
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Geographical breakdown
Country | Count | As % |
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United States | 1 | 50% |
Unknown | 1 | 50% |
Demographic breakdown
Type | Count | As % |
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Members of the public | 1 | 50% |
Mendeley readers
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France | 1 | 2% |
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Unknown | 45 | 92% |
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Other | 7 | 14% |
Student > Master | 6 | 12% |
Student > Bachelor | 3 | 6% |
Student > Doctoral Student | 2 | 4% |
Other | 7 | 14% |
Unknown | 10 | 20% |
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Economics, Econometrics and Finance | 2 | 4% |
Biochemistry, Genetics and Molecular Biology | 1 | 2% |
Nursing and Health Professions | 1 | 2% |
Other | 6 | 12% |
Unknown | 9 | 18% |