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Diagnosis of nosocomial bacterial pneumonia in intubated patients undergoing ventilation : comparison of the usefulness of bronchoalveolar lavage and the protected specimen brush [Article de Revue]

 
[Diagnostic des pneumonies bactériennes nosocomiales chez les patients intubés sous respiration assistée : comparaison entre l'utilité du lavage broncho-alvéolaire et celle du prélèvement par brosse]
SOLER P ; BORNET M ; HANCE A ; GIBERT C ; Chastre, J ; DOMART Y ; Trouillet, Jean-Louis ; Fagon, JY
Service de réanimation médicale. Hôpital Bichat. Paris. France
The American journal of medicine. 1988/10; (85) : 499-506
Summary: Objectif : Afin de comparer l'utilité des prélèvements protégés par brosse et ceux obtenus par lavage bronchoalvéolaire pour le diagnostic de pneumopathie nosocomiale qui survient chez des patients sous ventilation assistée, les deux procédures ont été réalisées chez les patients suspectés de pneumopathie du fait de la présence d'infiltrat pulmonaire et de sécrétions trachéales purulentes. Méthodes : 21 patients (16 hommes et 5 femmes) d'un âge moyen de 57 + ou - 12 ans ont été étudiés. Ils ont eu une ventilation mécanique de 8 + ou - 6 jours avant leur participation à l'essai. La suspicion de pneumopathie bactérienne nosocomiale était élevée chez ces patients. Une fibroscopie bronchique a été réalisée chez chaque patient. Les échantillons de la bronchoscopie ont été obtenus par prélèvements protégés par brosse et par lavage bronchoalvéolaire et ensuite les cultures ont été réalisées grâce à des techniques quantitatives en utilisant des méthodes standards. Conclusions : Le prélèvement protégé par brosse et l'identification microscopique de micro-organismes intracellulaires obtenus par le lavage bronchoalvéolaire sont utiles et apportent des informations complémentaires. Associés, ils permettent un traitement rapide et particulier de la plupart des patients qui présentent une pneumopathie noscomiale.

PURPOSE: To compare the usefulness of specimens recovered using a protected specimen brush and those recovered by bronchoalveolar lavage in the diagnosis of nosocomial pneumonia occurring in intubated patients undergoing ventilation, we performed both procedures in patients suspected of having pneumonia because of the presence of a new pulmonary infiltrate and purulent tracheal secretions. PATIENTS AND METHODS: Twenty-one patients (16 men and five women) with an average age of 57 +/- 12 years were studied. They had been receiving mechanical ventilation for 8 +/- 6 days before inclusion in the trial. The clinical suspicion for nosocomial bacterial pneumonia was high in these patients. Fiberoptic bronchoscopy was performed in each patient. Bronchoscopy specimens were obtained by a protected specimen brush and by bronchoalveolar lavage, and were then processed for quantitative bacterial and fungal culture using standard methods. Total cell counts were performed on an aliquot of resuspended original lavage fluid. Differential cell counts were made on at least 500 cells. In addition, 300 cells were examined at high-power magnification and the percentage of cells containing intracellular microorganisms and the average number of extracellular organisms per oil-immersion field were determined. RESULTS: Quantitative culture of specimens recovered using the protected specimen brush were positive (more than 10(3) colony-forming units [cfu]/ml) in five of five patients with subsequently confirmed pneumonia, and negative (less than 10(3) cfu/ml) in 13 of 13 patients without bacterial pneumonia, but results were not available until 24 to 48 hours after the procedure. Quantification of intracellular organisms in cells recovered by lavage was also useful in distinguishing patients with pneumonia (more than 25 percent of cells with intracellular organisms in five of five patients) from those without pneumonia (less than 15 percent of cells with intracellular organisms in all cases), and results were available immediately. In contrast, quantitative culture of lavage fluid and differential cell counts were of little value in identifying infected patients. CONCLUSION: The protected specimen brush and microscopic identification of intracellular organisms in cells recovered by lavage yield useful and complementary information, and together permit rapid and specific treatment of most patients with nosocomial pneumonia.(RESUME D'AUTEUR)
Publication
1988/10

Pages
499-506

Language
Anglais

Number of ref
23

ID notice
318808

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