PURPOSE: Infection remains a leading cause of morbidity and mortality after lung transplantation. Bacterial infection accounts for approximately one-half of infection related deaths, the majority of which are due to pneumonia. The optimal bronchoscopy sampling modality for the diagnosis of bacterial pneumonia in lung transplants recipients has not been prospectively studied.
METHODS: A total of 37 lung transplant recipients underwent concomitant bronchial washings, protected specimen bronchial brushing (PSB) and bronchioalveolar lavage (BAL). Infections were defined per AST guidelines. 17 of these patients did not have diagnostic criteria for pneumonia, while 20 were diagnosed with pneumonia. An assessment of agreement for the diagnosis of culture positive bacterial pneumonia among different bronchoscopy sampling modalities was completed using kappa (K) analysis.
RESULTS: Of 37 lung transplant recipients, 32% (12/37) had idiopathic pulmonary fibrosis, while 19% (7/37) each had cystic fibrosis and emphysema. 37% (10/37) of patients had undergone surveillance bronchoscopy in this cohort and 10% (1/10) of these patients were diagnosed with pneumonia with positive culture. The strength of agreement was highest with BAL (Kappa = 0.84), followed by moderate agreement with bronchial washings (Kappa= 0.64), and fair agreement with protected specimen bronchial brushings (Kappa= 0.51). The concordance rate for all three tests for negative culture was 70% (14/17), while the concordance rate among all three tests for positive cultures was 50% (10/20).
CONCLUSION: The data suggest that in lung transplant recipients undergoing bronchoscopy, BAL has the highest diagnostic yield for bacterial pneumonia. Moreover, concomitant bronchial washings or protected specimen bronchial brushing did not add any incremental value to the diagnosis of pneumonia over BAL.
CLINICAL IMPLICATIONS: BAL should be considere as the main diagnostic bronchoscopy sampling modality in those lung transplant recipients with clinical suspicion for bacterial pneumonia.
DISCLOSURE: Maria Crespo, No Financial Disclosure Information; No Product/Research Disclosure Information