Chastre J, Fagon J Y, Bornet-Lecso M, Calvat S, Dombret M C, al Khani R, Basset F, Gibert C
Service Central de Microbiologie, Hôpital Bichat, Paris, France.
Am J Respir Crit Care Med. 1995 Jul;152(1):231-40. doi: 10.1164/ajrccm.152.1.7599829.
To compare the usefulness of specimens obtained by bronchoalveolar lavage (BAL) and using a protected specimen brush (PSB) in the diagnosis of nosocomial pneumonia, both procedures were performed via fiberoptic bronchoscopy just after death in a series of 20 ventilated patients who had not developed pneumonia before the terminal phase of their disease and who had no recent changes in antimicrobial therapy. These results were compared with both histologic and microbiologic postmortem lung features in the same area. The total number of bacteria obtained by culture of lung segments and the latters' histologic grade were closely correlated (rho = 0.79, p < 0.0001). PSB and BAL quantitative culture results were strongly correlated with lung tissue values (rho = 0.67 and 0.75, respectively; p < 0.0001). Using discriminative values of > or = 10(3) and > or = 10(4) bacteria/ml to define positive PSB and BAL cultures, respectively, these techniques identified lung segments yielding > or = 10(4) bacteria/g tissue with sensitivities of 82 and 91% and specificities of 89 and 78%, respectively. Moreover, upon direct observation, the percentage of BAL cells containing intracellular bacteria was closely correlated with the total number of bacteria obtained from corresponding lung samples (p < 0.001). These findings indicate that bronchoscopic PSB and BAL samples very reliably identify both qualitatively and quantitatively microorganisms present in lung segments with bacterial pneumonia, even when the infection develops as a superinfection in a patient already receiving antimicrobial treatment for several days.
为比较支气管肺泡灌洗（BAL）和使用防污染样本毛刷（PSB）获取的样本在医院获得性肺炎诊断中的效用，在20例机械通气患者死亡后立即通过纤维支气管镜进行这两种操作，这些患者在疾病终末期前未发生肺炎，且近期抗菌治疗无变化。将这些结果与同一区域的组织学和微生物学尸检肺特征进行比较。肺段培养获得的细菌总数与后者的组织学分级密切相关（rho = 0.79，p < 0.0001）。PSB和BAL定量培养结果与肺组织值密切相关（rho分别为0.67和0.75；p < 0.0001）。分别使用≥10³和≥10⁴细菌/ml的判别值来定义PSB和BAL培养阳性，这些技术识别出每克组织中细菌≥10⁴的肺段，敏感性分别为82%和91%，特异性分别为89%和78%。此外，直接观察时，含有细胞内细菌的BAL细胞百分比与从相应肺样本中获得的细菌总数密切相关（p < 0.001）。这些发现表明，支气管镜下PSB和BAL样本能够非常可靠地定性和定量识别细菌性肺炎肺段中存在的微生物，即使感染是在已经接受抗菌治疗数天的患者中作为二重感染发生。
