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Empiric Treatments Impair the Diagnostic Yield of BAL in HIV-Positive Patients

Javier De Gracia; Marc Miravitlles; Cristina Mayordomo; Adelaida Ferrer; Antonio Alvárez; Carlos Bravo; Montserrat Vendrell
Author and Funding Information

Affiliations: From the Servei de Pneumologia, Hospital General Universitari Vail d'Hebron, Barcelona, Spain,  From the Departament de Microbiologia, Hospital General Universitari Vail d'Hebron, Barcelona, Spain

Affiliations: From the Servei de Pneumologia, Hospital General Universitari Vail d'Hebron, Barcelona, Spain,  From the Departament de Microbiologia, Hospital General Universitari Vail d'Hebron, Barcelona, Spain


1997 by the American College of Chest Physicians


Chest. 1997;111(5):1180-1186. doi:10.1378/chest.111.5.1180
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Abstract

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.

Method: 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.

Conclusion: 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.


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