Empiric treatments impair the diagnostic yield of BAL in HIV-positive patients.
OBJECTIVE
To investigate the influence of empiric treatments prior to fiberoptic bronchoscopy (FOB) on the diagnostic yield of BAL in HIV-positive patients with respiratory symptoms.


METHODS
We studied 123 consecutive FOBs with BAL in HIV-positive patients; 101 of these patients (82%) had received previous antimicrobial treatment from 1 to 60 days. Diagnostic yield of BAL for Pneumocystis carinii, Mycobacterium tuberculosis, and bacterial pneumonia was compared between patients with and without previous empiric treatments.


RESULTS
A diagnosis was obtained in 85 patients (69%), of whom 17 (20%) had multiple infections. Diagnostic yield was higher in patients without previous treatment, 91% (20/22) compared with 64% (65/101), p < 0.03. Diagnostic yield was also higher for bacterial pneumonia: seven isolations from 22 patients not receiving previous empiric treatment (32%), compared with 11 of those who had (11%; p < 0.02). The duration of empiric treatment against P carinii in patients in whom it was isolated was significantly shorter than in those in whom P carinii was not detected (3.5 +/- 1.8 days compared with 5.2 +/- 2.4 days; p = 0.003). FOB permitted a change in treatment in 62% of patients with a final diagnosis.


CONCLUSIONS
This study demonstrates that empiric treatments prior to FOB significantly impair the diagnostic yield of BAL in detecting common pathogens in HIV-infected patients with respiratory symptoms.
Gracia
J D
JD
Servei de Pneumologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
Miravitlles
M
M
Mayordomo
C
C
Ferrer
A
A
Alvárez
A
A
Bravo
C
C
Vendrell
M
M
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy; D000328:Adult; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D018893:Bronchoalveolar Lavage; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D001999:Bronchoscopy; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005336:Fiber Optic Technology; D006561:Herpes Simplex / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D010419:Pentamidine / Q000627:therapeutic use; D011010:Pneumocystis / Q000302:isolation & purification; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis / Q000188:drug therapy; D018139:Simplexvirus / Q000302:isolation & purification; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000935:Antifungal Agents; D000995:Antitubercular Agents; D010419:Pentamidine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination