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Diagnostic Fiberoptic Bronchoscopy in Patients With Community-acquired Pneumonia (5)

Diagnostic Fiberoptic Bronchoscopy in Patients With Community-acquired Pneumonia (5)Statistical Analysis
Results are expressed as mean ± SD. Quantitative cultures of BAL and TPC are compared by linear regression.
Results
In 28 (70 percent) of 40 cases of CAP studied, a definite etiology was confirmed by microbiologic methods. Results are shown in Table 1. Altogether, 31 microorganisms were cultured in significant counts; S pneumoniae (75 percent) and Haemophilus influenzae (21 percent) were the most frequent agents found (both agents in two cases).
Sputum Culture Results
Sputum cultures yielded S pneumoniae and H influenzae in nine (22 percent) and two (5 percent) cases, respectively. In all these cases the same organism was isolated in BAL culture, while TPC culture was positive in nine of them. In 18 (45 percent) cases, normal flora was obtained. In the remaining 12 (27 percent) cases, the patients were not able to expectorate or the sample was considered inadequate.
TPC and BAL Culture Results
The bacteria isolated in the TPC and BAL specimens are shown in Table 1. Remarkably, every time that TPC culture yielded a microorganism in pure culture, the same one was isolated from BAL sample. Accordingly, a qualitative agreement between TPC and BAL was achieved in nearly all cases. The exceptions were two cases of heavy BAL contamination with oral flora; in these cases, the bronchoscope was dislodged from the bronchus while performing BAL because of intense coughing. In none of the remaining cases was normal flora obtained.

Table 1—Bacteriology; Bewdts of Sputum, TPC, and BAL Cultures m 40 Cases of CAP

No/Age, yr/Sex SputumCulture TPC Culture BAL Culture DefiniteEtiology
1/18/M ND S pneumoniae 10s S pneumoniae 10s S pneumoniae
2/57/F ND S pneumoniae 1.6 x 103 S pneumoniae 10® S pneumoniae
3/22/M NF S pneumoniae 10* S pneumoniae 10е S pneumoniae
4/70/F NF Haemophilus influenzae 3 x 10* H influenzae 6 x 10® H influenzae
5/45/M ND S pneumoniae 1.1 x 104 S pneumoniae 9.8 x 104 S pneumoniae
6/28/M NF H influenzae 8 x 103 H influenzae 3 x 104 H influenzae
7/60/F S pneumoniae S pneumoniae 3 x 103 S pneumoniae 4 X 10® S pneumoniae
8/27/M NF S pneumoniae 2 x 104 S pneumoniae 10® S pneumoniae
9/78/F NF S pneumoniae 4 x 103 S pneumoniae 2.5 x 10® S pneumoniae
10/60/M H influenzae H influenzae 104 H influenzae 1.2 x 10® H influenzae
11/88/F H influenzae S pneumoniae 4 x 104 H influenzae 10® S pneumoniae 1.6 x 10® H influenzae 10® S pneumoniae and H influenzae
12/51/F S pneumoniae S pneumoniae 6 x 10® S pneumoniae 9 x 10s S pneumoniae
13/39/M NF S pneumoniae 3.8 x 104 S pneumoniae 1.5 x 10® S pneumoniaef
14/68/M NF S pneumoniae 107 H influenzae 107 S pneumoniae 107 H influenzae 107 S pneumoniae and H influenzae
15/56/M NF H influenzae 9.5 x 103 H influenzae 10® H influenzae
16/25/F NF S pneumoniae 1.5 x 104 S pneumoniae 1.6 x 10* S pneumoniae
17/33/M ND S pneumoniae 3 x 103 S pneumoniae 5 x 10® S pneumoniaef
18/16/M S pneumoniae S pneumoniae 3 x 10® S pneumoniae 6 x 10s S pneumoniae
19/52/M S pneumoniae S pneumoniae 107 S pneumoniae 107 S pneumoniae
20/52/M S pneumoniae S pneumoniae 4 x 104 S pneumoniae 2.5 x 104 S pneumoniaef
21/25/M NF S pneumoniae 104 S pneumoniae 1.5 x 10® S pneumoniae
22/18/F ND S pneumoniae 2 x 103 S pneumoniae 2.5 x 103 S pneumoniae
23/16/M ND S pneumoniae 3.5 x 103 S pneumoniae 2.3 x 103 S pneumoniaef
24/18/M ND H influenzae 104 H influenzae 8 x 103 H influenzae
25/64/M NF S pneumoniae 2.95 x 103 Contaminated S pneumoniae
26/78/M S pneumoniae S pneumoniae 1.4 x 105 S pneumoniae 1.5 x 103 S pneumoniae
27/17/M S pneumoniae S pneumoniae 8 x 103 S pneumoniae 4.6 x 103 S pneumoniaef
28/48/M ND S pneumoniae 800 M catarrhalis 1.5 x 104 S pneumoniae 8 x 10е M catarrhalis 4 x 103 S pneumoniae and M catarrhalis
29/29/M S pneumoniae Negative S pneumoniae 2 X 103 Doubtful
30/30/M NF Negative S pneumoniqe 1.8 x 103 Doubtful
31/26/M S pneumoniae Negative S pneumoniae 103 Doubtful
32/43/M ND S pneumoniae 350 S pneumoniae 350 Doubtful
33/29/F NF Negative S pneumoniae 1.8 x 104 Not defined
34/57/M ND Negative Negative Not defined
35/62/M ND Negative Negative Not defined
36/16/M ND Negative Negative Not defined
37/38/M NF Negative Negative Not defined
38/27/M NF Negative Contaminated Not defined
39/59/M NF Acinetobacter calcoaceticus 30 Acinetobacter calcoaceticus 110 Not defined
40/56/M NF S aureus 700 S aureus 40 Not defined

Category: Pulmonary disease

Tags: Bronchoscopy, etiology, normal flora, pneumonia

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