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(Chest. 1997;111:1180-1186.)
© 1997 American College of Chest Physicians

Empiric Treatments Impair the Diagnostic Yield of BAL in HIV-Positive Patients

Javier De Gracia MD, PhD1; Marc Miravitlles MD1; Cristina Mayordomo MD1; Adelaida Ferrer MD2; Antonio Alvárez MD1; Carlos Bravo MD1; and Montserrat Vendrell MD1

1 From the Servei de Pneumologia, Hospital General Universitari Vail d'Hebron, Barcelona, Spain
2 From the Departament de Microbiologia, Hospital General Universitari Vail d'Hebron, Barcelona, Spain

Objective: To investigate the influence of empiric treatments prior to fiberoptic bronchoscopy (FOB) on the diagnostic yield of BAL in HIV-positive patients with respiratory symptoms.

Method: We studied 123 consecutive FOBs with BAL in HIV-positive patients; 101 of these patients (82%) had received previous antimicrobial treatment from 1 to 60 days. Diagnostic yield of BAL for Pneumocystis carinii, Mycobacterium tuberculosis, and bacterial pneumonia was compared between patients with and without previous empiric treatments.

Results: A diagnosis was obtained in 85 patients (69%), of whom 17 (20%) had multiple infections. Diagnostic yield was higher in patients without previous treatment, 91% (20/22) compared with 64% (65/101), p<0.03. Diagnostic yield was also higher for bacterial pneumonia: seven isolations from 22 patients not receiving previous empiric treatment (32%), compared with 11 of those who had (11%; p<0.02). The duration of empiric treatment against P carinii in patients in whom it was isolated was significantly shorter than in those in whom P carinii was not detected (3.5±1.8 days compared with 5.2±2.4 days; p=0.003). FOB permitted a change in treatment in 62% of patients with a final diagnosis.

Conclusion: This study demonstrates that empiric treatments prior to FOB significantly impair the diagnostic yield of BAL in detecting common pathogens in HIV-infected patients with respiratory symptoms.

Key Words: AIDS • bacterial pneumonia • bronchoalveolar lavage • empiric treatment • HIV infection • Pneumocystis carinii pneumonia • pulmonary tuberculosis

Submitted on January 5, 1996
Accepted on December 12, 2007




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