Chow C, McGeer A, Kasupski G, Senathiragah N, Gallant P, Chan C
Princess Margaret Hospital, Wellesley Hospital and The Toronto Hospital, Department of Medicine, University of Toronto, Toronto, Ontario.
Can J Infect Dis. 1998 Mar;9(2):87-93. doi: 10.1155/1998/945704.
To evaluate the clinical utility of bronchoscopy with bronchoalveolar lavage (BAL) for diagnosing pulmonary infection in patients with underlying malignancy and to evaluate the impact of positive microbiology results on antimicrobial therapy.
Retrospective chart review.
University-affiliated downtown teaching hospital in Toronto.
All patients who underwent bronchoscopy with BAL from November 1990 to September 1992.
One hundred and thirty-nine BALs were performed, of which 82 (59%) were positive for microorganisms. These 82 charts were reviewed. The main underlying diagnosis was hemotogenous malignancy (70 of 82). Primary indiction for bronchoscopy was the presence of pulmonary symptoms with or without radiographic abnormality. Common organisms identified were fungi (n=50), primarily Candida albicans and cytomegalovirus (CMV) (27), and 16 'usual' pathogens. Less common were herpes simplex virus (six), Pneumoncystis carinii pneumonia (PCP) (four), Legionella pneumoniae and Mycoplasma pneumoniae (one each). Eighty-seven per cent of patients were on broad spectrum antibiotics at the time of bronchoscopy. Although antiibiotic therapy was altered postbronchoscopy in 47 of the 82 cases, only 26 instances could be directly attributed to the results of BAL. Pathogens that commonly initiated specific therapy were CMV (16 of 27) and PCP (three of four). Diagnostic yield was highest in allogenic bone marrow transplant recipients (BMT). They comprised only 49% (40 of 82) of the cases but accounted for 85% (22 of 26) of those whose therapy was directly altered by the results of BAL. Of these 22 cases, 20 were attributed to the isolation of CMV.
The overall raw diagnostic yield from bronchoscopy with BAL was high at 59%. Of those with positive BAL cultures, a change in antimicrobial management occurred in 32% of cases. In a patient poulation with underlying hematogenous malignancy, particularly BMT recipients, bronchoscopy with BAL is useful for a specfic diagnosis of pulmonary infection.
评估支气管镜检查联合支气管肺泡灌洗术（BAL）在诊断合并潜在恶性肿瘤患者肺部感染中的临床应用价值，并评估微生物学检查结果阳性对抗菌治疗的影响。
回顾性病历审查。
多伦多市大学附属市中心教学医院。
1990年11月至1992年9月期间所有接受支气管镜检查联合BAL的患者。
共进行了139次BAL检查，其中82次（59%）微生物检查结果呈阳性。对这82份病历进行了审查。主要潜在诊断为血行性恶性肿瘤（82例中的70例）。支气管镜检查的主要指征是存在肺部症状，伴有或不伴有影像学异常。鉴定出的常见病原体为真菌（n = 50），主要是白色念珠菌和巨细胞病毒（CMV）（27例），以及16种“常见”病原体。较少见的有单纯疱疹病毒（6例）、卡氏肺孢子虫肺炎（PCP）（4例）、嗜肺军团菌和肺炎支原体（各1例）。87%的患者在进行支气管镜检查时正在使用广谱抗生素。虽然82例中有47例在支气管镜检查后改变了抗生素治疗，但只有26例可直接归因于BAL的结果。通常引发特异性治疗的病原体是CMV（27例中的16例）和PCP（4例中的3例）。诊断阳性率在异基因骨髓移植受者（BMT）中最高。他们仅占病例的49%（82例中的40例），但占因BAL结果直接改变治疗方案患者的85%（26例中的22例）。在这22例中，20例归因于CMV的分离。
支气管镜检查联合BAL的总体原始诊断阳性率较高，为59%。在BAL培养结果阳性的患者中，32%的病例抗菌治疗方案发生了改变。在合并血行性恶性肿瘤的患者群体中，尤其是BMT受者，支气管镜检查联合BAL有助于对肺部感染进行特异性诊断。
