Diagnostic Value of Protected BAL in Diagnosing Pulmonary Infections in Immunocompromised Patients

¹ From the Pneumology Department, Hospital de la Santa Creu i Sant Pau., Universitat Autònoma de Barcelona, Barcelona, Spain
² From the Microbiology Service, Hospital de la Santa Creu i Sant Pau., Universitat Autònoma de Barcelona, Barcelona, Spain

Study objectives: To assess the diagnostic utility of protected BAL (P-BAL) in respiratory infections in immunocompromised patients and to examine whether P-BAL alone could substitute the combined use of protected specimen brush (PSB) and BAL in such patients.

Patients and study design: Thirty-seven immunocompromised patients who underwent PSB, P-BAL, and BAL simultaneously for the diagnosis or exclusion of bacterial or nonbacterial opportunistic respiratory infections were studied prospectively. The P-BAL was performed through the inner catheter of a telescoping plugged catheter with 60 mL of saline solution.

Main results: Thirteen (35%) cases of bacterial pneumonia were diagnosed. PSB obtained seven true-positive (TP) results, P-BAL obtained nine, and BAL obtained eight TP. Results of the three techniques were positive and concordant in 6 of the 13 cases. PSB remained free of contamination from oropharyngeal flora in all cases, P-BAL was contaminated twice, and BAL was contaminated in four cases. Opportunistic respiratory infections were diagnosed in 19 patients. P-BAL results were identical to those with BAL in all cases: 18 TP and 1 false-negative. The average volume of P-BAL fluid retrieved was 19 mL, sufficient for all microbiologic and cytologic processings. P-BAL was more time-consuming than both PSB and BAL procedures and was technically more complex.

Conclusion: P-BAL alone can substitute the combined use of both PSB and BAL in immunocompromised patients and attains a higher sensitivity than PSB in diagnosing bacterial pneumonia. The combined strategy continues to be a good choice, but due to the high incidence of bacterial pneumonia in these patients, a highly efficient diagnostic procedure is required not only for nonbacterial opportunistic respiratory infections but also for bacterial pneumonia.

Key Words: diagnosis • immunocompromised patients • pneumonia • protected bronchoalveolar lavage • respiratory infections

Submitted on November 4, 1994
Accepted on September 19, 1995

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