Zelus Casey S, Blaha Michael A, Samson Kaeli K, Kalil Andre C, Van Schooneveld Trevor C, Marcelin Jasmine R, Cawcutt Kelly A
Department of Internal Medicine, Division of Infectious Diseases, College of Public Health, University of Nebraska Medical Center, Omaha, NE.
Department of Anesthesiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE.
Crit Care Explor. 2022 Jun 8;4(6):e0708. doi: 10.1097/CCE.0000000000000708. eCollection 2022 Jun.
Pneumonia remains a significant cause of morbidity and mortality, with increasing interest in the detection and clinical significance of coinfection. Further investigation into the impact of bronchoalveolar lavage (BAL) sampling methodology and efficient clinical utilization of microbiological analyses is needed to guide the management of lower respiratory tract infection in the ICU.
Retrospective observational study.
ICUs at a single center between August 1, 2012, and January 1, 2018.
Mechanically ventilated adult patients who underwent BAL testing during an ICU admission were included.
None.
BAL methodology (bronchoscopic vs nonbronchoscopic), microbiological diagnostic testing, and clinical outcomes measures were obtained. Chi-square or Fisher exact tests assessed associations between categorical variables, whereas Kruskal-Wallis tests analyzed differences in distributions of measures. BAL samples from 803 patients met inclusion criteria. Coinfection was detected more frequently via bronchoscopic BAL compared with nonbronchoscopic BAL (26% vs 9%; < 0.001). Viruses were detected more frequently in bronchoscopic (42% vs 13%; < 0.001) and bacteria in nonbronchoscopic (42% vs 33%; = 0.011) BALs. A positive correlation between mortality and the number of organisms isolated was identified, with 43%, 48%, and 58% 30-day mortality among those with 0, 1, and more than 2 organisms, respectively ( = 0.003). Viral organism detection was associated with increased 30-day mortality (56% vs 46%; = 0.033).
Even in the setting of standardized institutional techniques, retrospective evaluation of bronchoscopic and nonbronchoscopic BAL methodologies did not reveal similar microbiologic yield in critically ill patients, though bronchoscopic BAL overall yielded more organisms, and occurrence of multiple organisms in BAL was associated with worse outcome. Prospective data are needed for direct comparison of both methods to develop more standardized approaches for use in different patient groups.
肺炎仍然是发病和死亡的重要原因，人们对合并感染的检测及其临床意义越来越感兴趣。需要进一步研究支气管肺泡灌洗（BAL）采样方法的影响以及微生物分析的有效临床应用，以指导重症监护病房（ICU）下呼吸道感染的管理。
回顾性观察研究。
2012年8月1日至2018年1月1日期间某单一中心的ICU。
纳入在ICU住院期间接受BAL检测的机械通气成年患者。
无。
获取BAL方法（支气管镜检查与非支气管镜检查）、微生物诊断检测及临床结局指标。卡方检验或Fisher精确检验评估分类变量之间的关联，而Kruskal-Wallis检验分析测量指标分布的差异。803例患者的BAL样本符合纳入标准。与非支气管镜BAL相比，支气管镜BAL检测到合并感染的频率更高（26%对9%；P<0.001）。支气管镜BAL中病毒检测更频繁（42%对13%；P<0.001），非支气管镜BAL中细菌检测更频繁（42%对33%；P = 0.011）。确定死亡率与分离出的生物体数量之间呈正相关，分别有0、1和超过2种生物体的患者30天死亡率为43%、48%和58%（P = 0.003）。病毒生物体检测与30天死亡率增加相关（56%对46%；P = 0.033）。
即使在标准化的机构技术条件下，对支气管镜和非支气管镜BAL方法的回顾性评估显示，重症患者的微生物学检出率并不相似，尽管支气管镜BAL总体上检出更多生物体，且BAL中出现多种生物体与更差的结局相关。需要前瞻性数据来直接比较这两种方法，以制定更适用于不同患者群体的标准化方法。
