Chest · 1997
Empiric treatments impair the diagnostic yield of BAL in HIV-positive patients.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Gracia J D, Miravitlles M, Mayordomo C, Ferrer A, Alvárez A, Bravo C, Vendrell M
Аннотация
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.
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.
Предметные рубрики MeSH
AIDS-Related Opportunistic InfectionsAdultAnti-Bacterial AgentsAnti-Infective AgentsAntifungal AgentsAntitubercular AgentsBacteriaBronchoalveolar LavageBronchoalveolar Lavage FluidBronchoscopyCytomegalovirusCytomegalovirus InfectionsFemaleFiber Optic TechnologyHerpes SimplexHumansLength of StayLung DiseasesMaleMiddle AgedMycobacterium tuberculosisPentamidinePneumocystisPneumonia, BacterialPneumonia, PneumocystisSimplexvirusTrimethoprim, Sulfamethoxazole Drug CombinationTuberculosis, Pulmonary