Empiric treatments impair the diagnostic yield of BAL in HIV-positive patients.
Chest
; 111(5): 1180-6, 1997 May.
Article
em En
| MEDLINE
| ID: mdl-9149567
ABSTRACT
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.
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Base de dados:
MEDLINE
Assunto principal:
Líquido da Lavagem Broncoalveolar
/
Infecções Oportunistas Relacionadas com a AIDS
/
Pneumopatias
/
Anti-Infecciosos
Tipo de estudo:
Diagnostic_studies
Idioma:
En
Ano de publicação:
1997
Tipo de documento:
Article