The utility of bronchoalveolar lavage fluid and serum galactomannan assay in patients with nonresolving pneumonia in a tertiary care hospital

Abstract Background There are limited data in real clinical practice on the diagnostic value of BAL (bronchoalveolar lavage) fluid galactomannan (GM) assay in patients with suspected invasive pulmonary aspergillosis (IPA) who had negative serum GM results. Methods This study was performed at Asan Medical Center, a 2700 bed tertiary-care hospital in Seoul, South Korea between May 2008 and April 2019. All patients with suspected IPA whose serum GM assays revealed negative results and sequentially underwent BAL were enrolled in this study. Patients were classified as proven, probable, possible or not IPA by the revised 2019 EORTC/MSG definition. Results A total of 341 patients with suspected IPA including 4 proven IPA, 38 probable IPA, 107 possible IPA, and 192 not IPA were enrolled. Of these 341 patients, 107 (31%) with possible IPA were excluded from the final analysis. Of 42 patients with proven or probable IPA who had initial negative serum GM results, 24 (57%) revealed positive BAL GM results (n=24) or BAL fungal culture (n=8). Among the remaining 18 (43%), 2 (5%) were diagnosed as proven IPA by the histopathologic exam from transbronchial lung biopsy, 6 (14%) as probable IPA by subsequent sputum fungal culture, and 10 (24%) as probable IPA by repeated serum GM assay after BAL. Of 192 patients with not IPA, 14 (7%) revealed positive BAL GM results (n=14) or BAL fungal culture (n=8). The diagnostic performance of various tests is shown in Table 1. Table 1. Diagnostic performance of various diagnostic tests in patients with suspected IPA who had negative serum GM results Conclusion Sequential BAL in patients with suspected IPA who had initial negative serum GM results provided additional diagnostic yield in about half of patients. Disclosures All Authors: No reported disclosures

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Inter-laboratory comparison of three different real-time PCR assays for the detection of Pneumocystis jiroveci in bronchoalveolar lavage fluid samples

Journal of Medical Microbiology ◽

10.1099/jmm.0.46552-0 ◽

2006 ◽

Vol 55 (9) ◽

pp. 1229-1235 ◽

Cited By ~ 40

Author(s):

Catharina F. M. Linssen ◽

Jan A. Jacobs ◽

Pieter Beckers ◽

Kate E. Templeton ◽

Judith Bakkers ◽

...

Keyword(s):

Bronchoalveolar Lavage ◽

Real Time ◽

Real Time Pcr ◽

Bronchoalveolar Lavage Fluid ◽

Medical Center ◽

Tertiary Care ◽

Lavage Fluid ◽

The Other ◽

Pneumocystis Jiroveci ◽

Pcr Assays

Pneumocystis jiroveci pneumonia (PCP) is an opportunistic infection affecting immunocompromised patients. While conventional diagnosis of PCP by microscopy is cumbersome, the use of PCR to diagnose PCP has great potential. Nevertheless, inter-laboratory validation and standardization of PCR assays is lacking. The aim of this study was to evaluate the inter-laboratory agreement of three independently developed real-time PCR assays for the detection of P. jiroveci in bronchoalveolar lavage fluid samples. Therefore, 124 samples were collected in three tertiary care laboratories (Leiden University Medical Center, Maastricht Infection Center and Radboud University Nijmegen Medical Centre) and were tested by both microscopy and real-time PCR. Of 41 samples positive for P. jiroveci by microscopy, 40 were positive in all three PCR assays. The remaining sample was positive in a single assay only. Out of 83 microscopy-negative samples, 69 were negative in all three PCR assays. The other 14 samples were found positive, either in all three assays (n=5), in two (n=2) or in one of the assays (n=7). The data demonstrate high inter-laboratory agreement among real-time PCR assays for the detection of P. jiroveci.

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Utility of bronchoalveolar lavage in cytology; a study at tertiary care hospital

Asian Pacific Journal of Health Sciences ◽

10.21276/apjhs.2014.1.4.9 ◽

2014 ◽

Vol 1 (4) ◽

pp. 362-364

Author(s):

V. M Bhagat ◽

◽

Hemali J Tailor ◽

Prashant R. Patel ◽

Mayur Adajania ◽

...

Keyword(s):

Bronchoalveolar Lavage ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital

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Cellular Profiles of Bronchoalveolar Lavage Fluid and Their Prognostic Significance for Non-HIV-Infected Patients with Pneumocystis jirovecii Pneumonia

Journal of Clinical Microbiology ◽

10.1128/jcm.03494-14 ◽

2015 ◽

Vol 53 (4) ◽

pp. 1310-1316 ◽

Cited By ~ 12

Author(s):

Ju Young Lee ◽

Hyun Jung Park ◽

Yong Kyun Kim ◽

Shinae Yu ◽

Yong Pil Chong ◽

...

Keyword(s):

Bronchoalveolar Lavage ◽

Tertiary Care ◽

Prognostic Significance ◽

Lavage Fluid ◽

Pneumocystis Jirovecii ◽

Pneumocystis Jirovecii Pneumonia ◽

Care Hospital ◽

Median Percentage ◽

Content Type ◽

Cellular Analysis

The usefulness of bronchoalveolar lavage (BAL) fluid cellular analysis in non-human immunodeficiency virus (HIV)-infected patients withPneumocystis jiroveciipneumonia (PCP) has not been adequately evaluated. The objective of this study was to analyze the cellular profiles of BAL fluid and to evaluate their prognostic significance in non-HIV-infected patients with PCP. A 7-year retrospective cohort study of 166 non-HIV-infected adult patients with PCP who underwent BAL was performed in a tertiary care hospital. The median total BAL fluid white blood cell count was 180/μl (interquartile range, 80 to 330) and was unaffected by the severity of PCP. The median percentages of BAL fluid neutrophils, lymphocytes, and alveolar macrophages were 13.1%, 31.7%, and 30.2%, respectively. The median percentage of BAL fluid neutrophils was significantly higher in severe than in mild-to-moderate PCP (20.4% versus 6.0%,P< 0.001), as was the absolute neutrophil count (24/μl versus 13/μl,P= 0.001). The percentage of BAL fluid neutrophils was an independent predictor of 30-day (adjusted odds ratio [aOR], 1.02; 95% confidence interval [CI], 1.01 to 1.03) and 60-day (aOR, 1.02; 95% CI, 1.01 to 1.04) mortalities. The 30-day and 60-day mortalities increased at rates of 15% (P= 0.006) and 21% (P< 0.001) per 10% increment of BAL fluid neutrophil levels, respectively. The degree of BAL fluid pleocytosis was relatively low without regard to the severity of PCP. The percentage of BAL fluid neutrophils can be used as a prognostic marker in non-HIV-infected patients with PCP.

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498. High Burden of CRO Colonization and Its Association with Infection Among Patients transferred to a Tertiary Care Hospital in India

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.567 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S242-S242

Author(s):

Smita Sarma ◽

Matthew Robinson ◽

Yatin Mehta

Keyword(s):

Infection Control ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Lavage Fluid ◽

Fisher Exact Test ◽

New Delhi ◽

Care Hospital ◽

Exact Test ◽

Increased Risk ◽

Carbapenemase Gene

Abstract Background Infections with carbapenem-resistant organisms (CRO) are increasing worldwide and are associated with high mortality. Patients transferred from outside hospitals have been reported to be at increased risk of CRO colonization and infection. The rate of subsequent CRO infection in patients colonized with CRO is unclear in a high CRO burden setting Methods Medanta Hospital in Gurgaon, India instituted CRO colonization screening for patients transferred from outside hospitals for infection control purposes. From April 2018 to May 2018, patients transferred from other hospitals to the intensive care unit at Medanta were subjected to CRO colonization screening using Xpert Carba R (Cepheid) performed on the day of transfer. Subsequent recovery of CRO in cultures of blood, bronchoalveolar lavage fluid, urine in specimens with pyuria obtained from patients without urinary catheters, pus, and tissue were considered to be indicative of CRO infection. The association of CRO colonization with subsequent CRO infection was assessed with a Fisher exact test Results Among 457 patients screened, 205 patients (45%) were found to be colonized with CRO at admission. Genes for New Delhi Metallo-β-lactamase (NDM) were detected in 184 (40%) patients, OXA-48 in 97 (21%) patients, VIM in 18 (4%) patients, KPC in 5 (1%) patients, and IMP1 in 5 (1%) patients; >1 carbapenemase gene was detected in 95 (21%) patients. CRO infections were observed in 25 (5%) patients including 12 with bacteremia, 7 with pneumonia, 4 with urinary tract infection, and 2 with soft-tissue infection. Among patients with CRO colonization, 17 (8%) patients developed CRO infection during the course of hospitalization; among patients without admission CRO colonization, subsequent CRO infection was found in 8 (3%) patients. CRO admission colonization was associated with subsequent clinical infection with CRO (odds ratio = 2.8, P = 0.02) Conclusion CRO colonization was found in almost half of patients transferred from outside hospitals to a large tertiary care hospital in India and was associated with subsequent CRO infection. Further work is necessary to understand the role of CRO colonization screening in infection control and antimicrobial stewardship in a setting with high CRO burden Disclosures All authors: No reported disclosures.

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