title: Pulmonary infiltrates in immunosuppressed patients: analysis of a diagnostic protocol.
abstract: A diagnostic protocol was started to study the etiology of pulmonary infiltrates in immunosuppressed patients. The diagnostic yields of the different techniques were analyzed, with special emphasis on the importance of the sample quality and the role of rapid techniques in the diagnostic strategy. In total, 241 patients with newly developed pulmonary infiltrates within a period of 19 months were included. Noninvasive or invasive evaluation was performed according to the characteristics of the infiltrates. Diagnosis was achieved in 202 patients (84%); 173 patients (72%) had pneumonia, and specific etiologic agents were found in 114 (66%). Bronchoaspirate and bronchoalveolar lavage showed the highest yields, either on global analysis (23 of 35 specimens [66%] and 70 of 134 specimens [52%], respectively) or on analysis of each type of pneumonia. A tendency toward better results with optimal-quality samples was observed, and a statistically significant difference was found in sputum bacterial culture. Rapid diagnostic tests yielded results in 71 of 114 (62.2%) diagnoses of etiological pneumonia.
authors.affiliation: Servei de Microbiologia, Institut Clínic d'Infeccions i Immunologia, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Danés
authors.forename: Julián
authors.initials: J
authors.lastname: González-Martín
authors.forename: Tomàs
authors.initials: T
authors.lastname: Pumarola
authors.forename: Ana
authors.initials: A
authors.lastname: Rañó
authors.forename: Natividad
authors.initials: N
authors.lastname: Benito
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.forename: Asunción
authors.initials: A
authors.lastname: Moreno
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rovira
authors.forename: Jorge
authors.initials: J
authors.lastname: Puig de la Bellacasa
mesh_terms: D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D001999:Bronchoscopy; D003470:Culture Media; D005260:Female; D015658:HIV Infections / Q000276:immunology*; D019337:Hematologic Neoplasms / Q000276:immunology*; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D008828:Microbiological Techniques / Q000379:methods; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology*; D013183:Sputum / Q000382:microbiology / Q000821:virology; D013997:Time Factors; D014180:Transplantation
chemical_list: D003470:Culture Media