Kashoub Masoud, Al-Jabri Al-Baraa, Al Rashdi Mohammed, Al-Aghbari Jamal
Department of Medicine, Sultan Qaboos University Hospital, University Medical City, Muscat, Oman.
College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
Sultan Qaboos Univ Med J. 2025 May 2;25(1):251-257. doi: 10.18295/2075-0528.2834.
Bronchoalveolar lavage (BAL) is an important diagnostic tool. Despite advancements in microbiological strategies, BAL's yield remains inconsistent. Hence, this study aimed to evaluate the yield of BAL in terms of microbial detection and correlate these results with computed tomography (CT) findings and antimicrobial usage duration before bronchoscopy.
This retrospective cohort study included all adult patients who underwent bronchoscopy with BAL at Sultan Qaboos University Hospital, Muscat, Oman, from January 2021 to December 2022.
A total of 203 patients underwent bronchoscopy. The primary indication for bronchoscopy was lung infiltrates in patients with haematological malignancies (49.3%). The overall BAL yield was 58.1%. All immunocompromised patients with a halo sign on CT scans had negative BAL galactomannan (GM) results ( = 0.559). In immunocompromised patients, there was a higher prevalence of negative BAL cultures with antibiotics usage, regardless of its usage duration, with rates of 72.7% and 71.4% for durations of 1-5 days and 6-10 days, respectively ( = 0.004). Similarly, there was increasing negative BAL GM in immunocompromised patients with longer antifungal usage durations (94.1% for 1-5 days compared to 100% for 6-10 days; = 0.610). The BAL yield was higher when more than 1 lobe was lavaged bilaterally (25.4%).
This study revealed a BAL diagnostic yield of 58.1%, aligning with existing literature. Performing BAL on both lungs may enhance this yield. No correlation was found between the CT findings and BAL GM results. The study highlights the importance of early BAL intervention before antimicrobial usage.
支气管肺泡灌洗（BAL）是一种重要的诊断工具。尽管微生物学策略有所进步，但BAL的检出率仍不一致。因此，本研究旨在评估BAL在微生物检测方面的检出率，并将这些结果与计算机断层扫描（CT）结果以及支气管镜检查前的抗菌药物使用时间相关联。
这项回顾性队列研究纳入了2021年1月至2022年12月在阿曼马斯喀特苏丹卡布斯大学医院接受BAL支气管镜检查的所有成年患者。
共有203例患者接受了支气管镜检查。支气管镜检查的主要指征是血液系统恶性肿瘤患者的肺部浸润（49.3%）。BAL的总体检出率为58.1%。所有CT扫描显示有晕征的免疫功能低下患者BAL半乳甘露聚糖（GM）结果均为阴性（P = 0.559）。在免疫功能低下的患者中，无论抗菌药物使用时间长短，使用抗菌药物后BAL培养阴性的患病率更高，使用1 - 5天和6 - 10天的阴性率分别为72.7%和71.4%（P = 0.004）。同样，免疫功能低下的患者使用抗真菌药物时间越长，BAL GM阴性率越高（1 - 5天为94.1%，6 - 10天为100%；P = 0.610）。双侧灌洗超过1个肺叶时BAL检出率更高（25.4%）。
本研究显示BAL诊断检出率为58.1%，与现有文献一致。对双肺进行BAL可能会提高检出率。未发现CT结果与BAL GM结果之间存在相关性。该研究强调了在使用抗菌药物之前尽早进行BAL干预的重要性。
