Treatment of bronchiectasis with intratracheal antibiotics instillation and the significance of bacteriological tests of the sputum from the trachea

Abstract

Intratracheal instillation therapy with antibiotics was given to 43 cases of bronchiectasis. Of them, 21 cases were markedly and 22 cases were moderately improved. Intratracheal instillation was done by intercartilagenous puncture once every or every other day. This method is simple, easy and safe in repeating. Tracheal sputa are completely free from contamination from oral and pharyngeal cavity. The patterns of intratracheal bacterial flora were constant and stable in each individual case through the course of treatment.In 43 cases of bronchiectasis tracheal sputa were examined aerobically. In 9 cases no aerobic bacteria were cultured and 66.7% of them were markedly improved. In 12 cases Streptococci and/or Staphylococci were cultured and 50.0% were markedly improved. In 13 cases Coli-Paracolon group with or without Streptococci and/or Staphylococci were cultured and 61.5% were markedly improve. In 9 cases Pseudomonas with or without Streptococci and/or Staphylococci and/or Coli-Paracolon group were cultured and 11.1% were markedly improved.In 34 cases with positive aerobic culture, Streptococci were obtained in 21 cases and Coli-Paracolon group in 15 cases, Staphylococci in 11 cases and Pseudomonas in 9 cases.In 15 cases of bronchiectasis tracheal sputa and expectorated sputa were cultured on chocolate agar plates. In tracheal sputa of 2 cases Hemophilus were cultured, whereas, in expectrated sputa of 5 cases Hemophilus were cultured.Considering these bacteriological patterns, antibiotics were selected: Penicillin to negative culture cases and cocci infection cases; Therramycin or Kanamycin to bacilli infection cases; Penicillin, Terramycin or Kanamycin, alone or alterately, to mixed infection cases.Thirty one cases of bronchiectasis were divided into three groups according to the extent of the lesions, 12 cases of (+) group, 9 cases of group and 10 cases of group. Gram-negative bacilli were found in 42.8% of (+) groups, whereas, 60.0% of group. Thirty one cases of bronchiectasis were grouped into three groups according to duration before the chemotherapy, 12 cases of less than 5 years duration, 9 cases of less than 10 years and 10 cases of more than 10 years. Gramnegative bacilli were found in 47.6% of less than 5 and 10 years group, whereas, in 70.0% of more than 10 years group.The infection of Gram-negative bacilli, the longer duration of the disease before this therapy and the greater extent of the lesions are, relating each other, the main causes of lowering the cure rate of bronchiectasis.