Abstract
IntroductionHealth 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.MethodsWe 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.ResultsWe 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.ConclusionsFODP 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.See related letter by Sircar et al.,http://ccforum.com/content/17/2/428
Highlights
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
That is why guidelines recommend the use of broad-spectrum and multiple antibiotics in patients presenting with HCAP [4]
We conducted a prospective study to assess whether fiberoptic bronchoscope-guided distal-protected small volume bronchoalveolar lavage (FODP mini-BAL) with quantitative cultures was more efficient than blood cultures to identify pathogens in patients presenting with HCAP with the ratio of identification between the techniques as principal criteria
Summary
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. This strategy may be economically expensive and promote antimicrobial resistance when a multisensitive pathogen is not identified. Health care-associated pneumonia (HCAP) is associated with higher mortality than community-acquired pneumonia, because patients presenting with HCAP are at risk of multidrug-resistant (MDR) pathogens and seem to receive initially inappropriate therapy [1]. That is why guidelines recommend the use of broad-spectrum and multiple antibiotics in patients presenting with HCAP [4]. Mini-bronchoalveolar lavage (BAL) has been shown to be a useful tool in identifying pathogens, as in ventilator-associated pneumonia, with identification in up to 46.2% of cases, or in acute hypoxemic respiratory failure requiring noninvasive ventilation [8,9]
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