Bronchoalveolar lavage in mechanically ventilated patients with suspected pneumonia: a descriptive study

Objective

To describe etiologic agents, the antibiotic use and the clinical outcome of pneumonia patients who require mechanical ventilation.

Methods

Seventy-three consecutive mechanically ventilated patients with suspected pneumonia and BAL recruited between November 2003 and December 2005 were registered. The ICU length of stay, time on mechanical ventilation (MV), mortality, isolated bacteria, and antimicrobial susceptibility were collected.

Results

Twelve immunocompromised patients were excluded. A total of 61 cases of suspected pneumonia were recruited (Table 1), including eight (13.1%) cases of community-associated pneumonia (CAP), 20 (32.7%) cases of early-onset ventilator-associated pneumonia (VAP < 5 days), and 33 (54.09%) cases of late-onset ventilator-associated pneumonia (VAP ≥ 5 days).

Table 1 (abstract P69)

Twenty-eight patients (84.8%) with late-onset VAP received antibiotics before performing BAL, as compared with 12 (60%) with early-onset VAP and five patients (71.4%) with CAP.

BAL was positive (>10,000 ufc/ml) in 36.4%, 60% and 14.3% of late-onset VAP, early-onset VAP and CAP, respectively. The ICU length of stay was significantly longer for patients with CAP and late-onset VAP than for early-onset VAP patients. Mortality was 24.2%, 35% and 28.6% due to late-onset VAP, early-onset VAP and CAP, respectively. CAP and early onset VAP were mostly caused by antibiotic sensitive bacteria, while late-onset VAP were caused more frequently by multiple pathogens with an inadequate prior antibiotic treatment.

Conclusion

The low incidence of positive BAL in the CAP group underwrites the use of BAL only for particularly severe, selected cases. Although there was a difference in the isolated bacteria and antibiotic susceptibility among different kinds of pneumonia, the mortality was the same. Inadequate prior antibiotic therapy was more frequent in the late-onset VAP group.