Diagnostic value of protected BAL in diagnosing pulmonary infections in immunocompromised patients.
OBJECTIVE
To assess the diagnostic utility of protected BAL (P-BAL) in respiratory infections in immunocompromised patients and to examine whether P-BAL alone could substitute the combined use of protected specimen brush (PSB) and BAL in such patients.


METHODS
Thirty-seven immunocompromised patients who underwent PSB, P-BAL, and BAL simultaneously for the diagnosis or exclusion of bacterial or nonbacterial opportunistic respiratory infections were studied prospectively. The P-BAL was performed through the inner catheter of a telescoping plugged catheter with 60 mL of saline solution.


RESULTS
Thirteen (35%) cases of bacterial pneumonia were diagnosed. PSB obtained seven true-positive (TP) results, P-BAL obtained nine, and BAL obtained eight TP. Results of the three techniques were positive and concordant in 6 of the 13 cases. PSB remained free of contamination from oropharyngeal flora in all cases, P-BAL was contaminated twice, and BAL was contaminated in four cases. Opportunistic respiratory infections were diagnosed in 19 patients. P-BAL results were identical to those with BAL in all cases: 18 TP and 1 false-negative. The average volume of P-BAL fluid retrieved was 19 mL, sufficient for all microbiologic and cytologic processings. P-BAL was more time-consuming than both PSB and BAL procedures and was technically more complex.


CONCLUSIONS
P-BAL alone can substitute the combined use of both PSB and BAL in immunocompromised patients and attains a higher sensitivity than PSB in diagnosing bacterial pneumonia. The combined strategy continues to be a good choice, but due to the high incidence of bacterial pneumonia in these patients, a highly efficient diagnostic procedure is required not only for nonbacterial opportunistic respiratory infections but also for bacterial pneumonia.
Jolis
R
R
Pneumology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain.
Castella
J
J
Puzo
C
C
Coll
P
P
Abeledo
C
C
D000328:Adult; D000368:Aged; D018893:Bronchoalveolar Lavage / Q000379:methods; D001992:Bronchoalveolar Lavage Fluid; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000276:immunology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000276:immunology*; D012680:Sensitivity and Specificity