Chest
Original ResearchChest InfectionsBAL Neutrophils, Serum Procalcitonin, and C-Reactive Protein To Predict Bacterial Infection in the Immunocompromised Host
Section snippets
Patients
This study was approved by the institutional review board and performed at the University Hospital Basel, a 784-bed tertiary care hospital located in Basel, Switzerland. One hundred seven consecutive hospitalized immunocompromised patients who were referred to the pulmonary division for diagnostic bronchoscopy within a period of 8 months in 2005 were included in this prospective cohort study. Eligibility criteria included the following: (1) immunocompromised state; (2) age > 18 years; (3) a
Baseline Characteristics of Patients
Underlying conditions and baseline characteristics of the 107 patients are presented in Table 1, Table 2. Most common underlying conditions were hematologic malignancies that were treated by high dose chemotherapy alone (n = 29) or combined with allogeneic stem cell transplantation (n = 26) followed by solid organ transplantation (n = 20). Overall, 20 patients (18.7%) had neutropenia at the time of bronchoscopy.
The median length of hospital stay before bronchoscopy was 2 days (interquartile
Discussion
In this study, we found that clinical parameters were not useful for the differential diagnosis of pulmonary complications in immunocompromised patients. In contrast, neutrophilia in the BAL fluid as well as increased serum levels of CRP and procalcitonin were significantly associated with bacterial pulmonary infection. The percentage of neutrophils in BAL fluid showed the best diagnostic accuracy for predicting bacterial infection in the ROC curve analysis, followed by procalcitonin level and
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2018, Pulmonary Pharmacology and TherapeuticsCitation Excerpt :Diagnostic bronchoscopy was performed, according to standard procedures, under conscious sedation [13]. BAL was performed by 3 repeated installations of 50 ml of 0.9% NaCl [14,15]. Recovered BAL was filtered through a gauze swab, centrifuged (400×g, 10 min) and the cell-free BAL fluid was collected and stored at −80 °C.
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2016, ChestCitation Excerpt :Cytologic analysis of BAL samples, including differential cell count, was performed.19,22 Microbiologic analysis of BAL samples included appropriate stains, cultures, and polymerase chain reaction for bacteria, mycobacteria, fungi, and Pneumocystis jirovecii.19 Viral infections were also investigated for respiratory viruses such as rhinovirus, herpes simplex virus type 1 and 2, cytomegalovirus, respiratory syncytial virus, and adenovirus, by polymerase chain reaction, culture, or immunofluorescence.19
The study was presented in part at the 16th Annual Congress of European Respiratory Society, Munich, 2006 and was honored with the Research Excellence Award in Respiratory Infections.
Drs. Stolz and Müller have received payments from BRAHMS (the manufacturer of procalcitonin assays) to attend advisory board meetings and speaker engagements, or for research. Drs. Stulz, Gratwohl, and Tamm have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.