PURPOSE: To investigate the use of antibiotics before and after bronchoscopy in mechanically ventilated patients in the Intensive Care Unit.
METHODS: A retrospective chart review of all mechanically ventilated patients who underwent bronchoscopy from January 2005 to December 2005.
RESULTS: A total of 36 bronchoscopies were performed on 28 patients. In 64%(23/36)of the cases, changes in management occurred on the day of the procedure or after bronchial alveolar lavage(BAL) cultures were obtained. 74%(17/23) of the cases had antibiotics added or changed. 17%(4/23) had antibiotics stopped. 1 patient had the antibiotic dose increased and 1 patient had antibiotics started after having been on none. 69%(25/36) of the total cases had a BAL positive for organisms. 78%(18/23) of the cases that had a management change were BAL positive for organisms. Of the 5 remaining cases with a negative BAL, 2 had their antibiotics discontinued. 36%(13/36) of cases lead to no change in management. Of those 13 cases, 46%(6/13) had a negative BAL for organisms. The remaining 7 were BAL positive for bacterial and/or fungal organisms. 86%(6/7) of those positive cases were appropriately covered with antibiotics and/or antifungal agents.
CONCLUSION: Bronchoscopy and BAL cultures strongly impacted clinical management in ICU patients leading to antibiotics being added, changed, increased in dose, or started. Antibiotics appeared to be inappropriately continued in the face of a negative BAL finding.
CLINICAL IMPLICATIONS: Historically bronchoscopy with BAL is a very safe procedure in the ICU and should be heavily utilized in the management of mechanically ventilated patients. Opportunities for de-escalation management of antibiotics can be strongly enhanced with the use of bronchoscopy.
DISCLOSURE: Frederick Beckett III, None.