Low specificity of the bacterial index for the diagnosis of bacterial pneumonia by bronchoalveolar lavage.
Eur J Clin Microbiol Infect Dis
; 17(2): 78-84, 1998 Feb.
Article
en En
| MEDLINE
| ID: mdl-9629970
The bacterial index (BI) as defined by the sum of log10 colony-forming units (cfu) of microorganisms per milliliter of bronchoalveolar lavage (BAL) fluid, i.e., a multiplication of the single cfu/ml, has been used to distinguish between polymicrobial pneumonia (BI> or =5) and colonization (BI<5). Since many false-positive results are to be expected using this parameter, the diagnostic value of the BI was studied prospectively by obtaining bacteriologic cultures of BAL fluid in 165 consecutive unselected patients. In 27 cases the diagnosis of bacterial pneumonia was established on clinical criteria. In 133 patients pneumonia could be excluded, and in five patients the diagnosis remained unclear. Using a cut-off of > or = 10(5) cfu/ml BAL fluid, sensitivity and specificity for the diagnosis of pneumonia were 33% (9/27) and 99% (132/133), respectively. Sensitivity was mainly influenced by prior treatment with antibiotics, being 70% (7/10) in untreated and 12% (2/17) in treated patients. Applying the BI methodology at a cut-off of > or =5, however, resulted in an unacceptably high rate of 16 additional false-positive results, thus lowering the specificity to 87% (116/133; P<0.0001) while increasing the sensitivity to only 41% (11/27; P = 0.77). In conclusion, given the high rate of false-positive results, the methodology of the BI is of doubtful value for the diagnosis of bacterial pneumonia by BAL in an unselected patient group. By applying the absolute number of cfu/ml BAL fluid, however, positive bacteriologic cultures of BAL fluid are highly specific for the diagnosis of pneumonia. Their sensitivity is limited by previous antibiotic therapy.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Bacterias
/
Líquido del Lavado Bronquioalveolar
/
Recuento de Colonia Microbiana
/
Neumonía Bacteriana
Tipo de estudio:
Diagnostic_studies
/
Observational_studies
Límite:
Adolescent
/
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Eur J Clin Microbiol Infect Dis
Asunto de la revista:
DOENCAS TRANSMISSIVEIS
/
MICROBIOLOGIA
Año:
1998
Tipo del documento:
Article
País de afiliación:
Suiza
Pais de publicación:
Alemania