Artigo

Direct examination and cultures of bronchoalveolar lavage in pneumonia diagnosis: a comparative experimental study

NILTON BRANDAO DA SILVA, LUCAS MARTINS , FREDERICO MARTINS , JOSÉ ANFLOR, JR. , CRISTIANO KOEFENDER , JOSÉ MOREIRA , TIAGO TONIETTO , PAULO G. CARDOSO

Intensive Care Medicine, v. 33, n. 0, p. 1840-1847, 2007.

Motivo: Produção Colaborador HMV

Setor HMV: CTI Adulto

Área da saúde: Medicina Intensiva

Resumo: Objective: To assess the accuracy of direct examination and quantitative cultures of BAL to diagnose pneumonia with or without antibiotic treatment. Design: Experimental rat models. Interventions: Pneumonia was induced by intratracheal inoculation of S. pneumoniae (109 cfu/ml) or P. aeruginosa (108 cfu/ml). Controls (n = 10) received sterile inoculum. Study animals received penicillin (n = 19) or saline (n = 18) (pneumococcal model); amikacin (n = 13), ceftazidime (n = 11), or saline (n = 13) (Pseudomonas model). BAL was assessed 48 h after infection. The animals were killed for histopathological analysis. Results: All study animals developed pneumonia, which was more extensive in the pneumococcal than in the Pseudomonas model. In pneumococcal pneumonia the sensitivity of BAL cultures (103 cfu/ml or higher) was 77.8% with saline and 21.0% with penicillin. In the Pseudomonas ceftazidime group all specimens were negative, precluding diagnosis. The sensitivity of cultures with amikacin was 23.1% vs. 30.8% with saline. In the pneumococcal model intracellular organism (ICO) count of 2% or higher had a sensitivity of 100% for detecting pneumonia with saline and 57.9% with penicillin. In the Pseudomonas model the sensitivity of ICO was 69.2% with both amikacin and saline and 36.3% with ceftazidime. The sensitivity of neutrophil count above 50% in pneumococcal pneumonia was 77.8% and 64.7% with saline and penicillin, espectively, and 69.2%, 61.5%, and 81.8% with saline, amikacin, and ceftazidime, respectively, in Pseudomonas pneumonia. Conclusions: BALpositive intracellular organisms were more accurate than cultures for the diagnosis of recent pneumonia, and were less affected by antibiotic treatment.

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