Abstract
Despite the use of quantitative culture, oropharyngeal contamination of bronchoalveolar lavage (BAL) specimens is still a factor that limits the usefulness of this technique in the diagnosis of lower respiratory tract infection. To investigate whether special precautions could reduce contamination, 20 noninfected patients undergoing diagnostic bronchoscopy were randomized into 2 groups of 10 patients: BAL was performed routinely in group R and with special precautions in group P. These precautions consisted of giving topical lidocaine by inhalation rather than by bolus injection, and passing the bronchoscope used for BAL through a previously inserted endotracheal tube. Quantitative culture of BAL specimens showed that 5 patients in group R (50%), but none of the patients in group P (0%), had at least 1 organism recovered in concentrations ≥104 colony-forming units CFU/ml (p=0.016). Fifteen of 39 isolates (38.5%) in group R and none of 18 isolates in group P (0%) were present in concentration ≥104 CFU/ml (p=0.001). We conclude that oropharyngeal contamination of BAL specimens can be minimized by adopting special precautions during the procedure and by using quantitative culture with 104 CFU/ml as the cut-off point. This may increase the specificity of the technique in the diagnosis of lower respiratory tract infection without reducing its sensitivity.
Similar content being viewed by others
References
Bartlett JG, Alexander J, Mayhew J, Sullivan-Sigler N, Gorbach SL (1976) Should fiberoptic bronchoscopy aspirates be cultured? Am Rev Respir Dis 114:73–78
Fossieck BE, Parker RH, Cohen MH, Kane RC (1977) Fiberoptic bronchoscopy and culture of bacteria from the lower respiratory tract. Chest 72:5–9
Gove RI, Wiggins J, Stableforth DE (1985) A study of the use of ultrasonically nebulized lignocaine for local anaesthesia during fibreoptic bronchoscopy. Br J Dis Chest 79:49–59
Johanson WG, Seidenfeld JJ, Gomez P, De los Santos R, Coalson JJ (1988) Bacteriologic diagnosis of nosocomial pneumonia following prolonged mechanical ventilation. Am Rev Respir Dis 137:259–264
Kahn FW, Jones JM (1987) Diagnosing bacterial respiratory infection by bronchoalveolar lavage. J Infect Dis 155:862–869
Stover DE, Zaman MB, Hajdu SI, Lange M, Gold J, Armstrong D (1984) Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host. Ann Intern Med 101:1–7
Thorpe JE, Baughman RP, Frame PT, Wesseler TA, Staneck JL (1987) Bronchoalveolar lavage for diagnosing acute bacterial pneumonia. J Infect Dis 155:855–861
Wimberley NW, Bass JB, Boyd BW, Kirkpatrick MB, Serio RA, Pollock HM (1982) Use of a bronchoscopic protected catheter brush for the diagnosis of pulmonary infections. Chest 81:556–562
Wimberley N, Faling LJ, Bartlett JG (1979) A fiberoptic bronchoscopy technique to obtain uncontaminated lower airway secretions for bacterial culture. Am Rev Respir Dis 119:337–343
Zavala DC (1978) Flexible fiberoptic bronchoscopy. Press of Pepco Litho, Cedar Rapids, Iowa
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Pang, J.A., Cheng, A.F.B., Chan, H.S. et al. Special precautions reduce oropharyngeal contamination in bronchoalveolar lavage for bacteriologic studies. Lung 167, 261–267 (1989). https://doi.org/10.1007/BF02714955
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02714955