PURPOSE:Health Care Associated Pneumonia (HCAP) is an important cause of morbidity and mortality in the critical care settings. Lower respiratory tract culture can be obtained via endotracheal tube aspiration (ETA), or via bronchoalveolar lavage BAL. We conducted a study to evaluate whether BAL compared to ETA culture will result in a change in the management of patients intubated with pneumonia.
METHODS:We reviewed the medical records of patients on mechanical ventilations with a diagnosis of Pneumonia, who had ETA and BAL specimens sent for culture. We analyzed the microbiology and the antibacterial sensitivity of bacterial isolates of ETA and BAL cultures. Similar sensitivity pattern was defined as 2 or more bacteria sensitive to the same group of antibiotics.
RESULTS:A total of 25 patients were included in the study, ETA and BAL samples were taken less than 3 days apart in 21 of 25 (84%) and in 4 to10 days apart in 4 (16%). Different bacteria were isolated in BAL and ETA culture in 13 out of 25 (52%), same bacteria were isolated in 12 (48%). Among those 13 patients with different microbiology pattern; different sensitivity patterns were found in 3 out of 25 (12%) and similar sensitivity pattern in 7 out of 25 (28%), in the other 3 (12%) either ETA or BAL culture was negative. A change in antibiotics regimen was made in 7 out of 25 patients (28%). Antibiotics were discontinued in 1 out of 25 (4%), deescalated in 1 (4%), changed in 2 (8%), and new antibiotics added in 3 (12%).
CONCLUSION:BAL culture resulted in a change in the current antibiotic regimen in 28% of the patients compared to ETA culture.
CLINICAL IMPLICATIONS:A larger prospective study with BAL and ETA collected at the same time should be conducted to better evaluate the use of BAL in the antibiotics management of patients intubated with pneumonia.
DISCLOSURE:Jeannot Michel, No Financial Disclosure Information; No Product/Research Disclosure Information