İsmail YÜKSEKOL, Kudret EKİZ, Yücel TAŞAN, Arzu BALKAN, Metin ÖZKAN, Hayati BİLGİÇ, Necmettin DEMİRCİ

Pnömoninin etyolojik tanısında "Protected Bronchoalveolar Lavage" in değeri

Pnömonilerin erken tanısında "Protected Bronchoalveolar Lavage (P-BAL)" kantitatif kültürlerinin önemini araştırmak üzere kliniğimizde yatan 22 ağır toplum kökenli, 8 hastane kökenli, 5 radyografik infiltrasyonlu ve 10 pnömoni dışı nedenlerle bronkoskopi uygulanan olgu (kontrol grubu olarak) çalışmaya alındı.Kantitatif kültürler için anlamlı kabul edilecek eşik değer $10^4$ cfu/mL (colony forming unit/mililiter) olarak kabul edildi.Kontrol grubunda 10 olgudan 1' inde anlamlı üreme oldu (yalancı pozitif, %10).Pnömoni kliniği olmayıp sadece radyografik infiltrasyon olan 5 olgunun P-BAL materyalinde ARB, direkt bakı ve kültürle pozitif saptandı.Toplam 30 pnömoni olgusunun 28' inde anlamlı üreme oldu (%93).Bu sonuçlarla P-BAL' ın özellikle hastanede tedavi edilen hastalarda gereksiz antibiyotik kullanımı önlemek için pnömoni tanısında kullanılabileceğini düşünüyoruz.

Diagnostic value of protected bronchoalveolar lavage in the etiologic diagnosis of pneumonia

To investigate the reliability of quantitative cultures of protected bronchoalveolar lavage (P-BAL) in the early diagnosis of pneumonia, 22 patients with severe community acquired pneumonia, 8 patients with nosocomial pneumonia, 5 patients with only radiographic infiltration, and 10 patients who were underwent bronchoscopy for reasons other than pneumonia (as a control group) were examined.For a positive quantitative culture the "cut-off" value was a accepted as $10^4$ cfu/mL.In control group only one patient had a positive culture (false positive 10%).In group with only radiographic infiltration 5 patients were proved as positive for acid fast bacille (AFB) by direct examination and culture of P-BAL material.Twenty eight of 30 patients with pneumonia had positive cultures (93 %).From these results we conclude that in especially hospitalized patients to preclude the unnecessary antibiotic use, P-BAL can be used to diagnose pneumonia.

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