Guillaume Lacroix, Bertrand Prunet, Julien Bordes, Nathalie Cabon-Asencio, Yves Asencio, Tiphaine Gaillard, Sandrine Pons, Erwan D’Aranda, Delphine Kerebel, Eric Meaudre, Philippe Goutorbe Critical Care 2013, 17:R24 (5 February 2013)
Introduction: Health care-associated pneumonia (HCAP) has been proposed as a new category of respiratory infection to identify patients at risk of multidrug-resistant (MDR) pathogens. The American Thoracic Society’s recommendation for HCAP treatment is to use broad-spectrum and multiple antibiotics. However, this strategy may be economically expensive and promote antimicrobial resistance when a multisensible pathogen is not identified.
Methods: We prospectively included all patients presenting with HCAP in the emergency department. Blood cultures and fiberoptic bronchoscope-guided distal protected small volume bronchoalveolar lavage (FODP mini-BAL) were performed in each patient. Empiric antibiotic therapy was adapted microbiological findings were available. The primary objective was to assess that FODP mini-BAL is more efficient than blood cultures to identify pathogens with the ratio of identification between both techniques as principal criteria.
Results: We included 54 patients with HCAP. Pathogens were identified in 46.3% of cases using mini-BAL, and in 11.1% of cases using blood cultures (p < 0.01). When patient did not receive antibiotic therapy before the procedure, pathogens were identified in 72.6% of cases using mini-BAL, and in 9.5% of cases using blood cultures (p<0.01). We noted multidrug-resistant pathogens in 16% of cases. All bronchoscopic procedures could be performed in patients without complications.
Conclusions: FODP mini-BAL was more efficient than blood cultures for identifying pathogens in patients presenting with HCAP. When bacteriological identification was obtained, antibiotic therapy was adapted in 100% of cases.
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