During the period December 19, 1986 to November 24, 1989, 62 diagnostic fiberoptic bronchoscopies on 53 patients with suspected pulmonary infections were performed at the Lund Hospital. All these patients were evaluated in the study. The median age of the patients was 49 years (range, 24 to 79 years). Five of the 62 bronchoscopies were done on 4 patients who tested positive for human immunodeficiency virus (HIV) and 2 bronchoscopies were done on a patient who tested positive for hepatitis В surface antigen. Eight bronchoscopies were performed on patients receiving mechanical ventilation, and one other patient was examined during general anesthesia.
The patients were examined with bronchoscopy for the following reasons: pneumonia in immunocompromised patients (n = 30), therapeutic failure while receiving conventional antibiotics (n = 24), suspected tuberculosis (n = 11), lung abscess (n = 4), pneumonia in combination with acute respiratory failure (n=4), and recurrent pneumonia (n = l). Some patients were examined on the basis of more than one of the above. Of the 24 patients who had received prior antibiotics, 6 were also immunocompromised, 2 had suspected tuberculosis, and 1 had a lung abscess. Of the immunocompromised patients, 20 percent (6/30) were treated with antibiotics prior to the bronchoscopy, while 56 percent (18/32) of the immunocompetent patients received prior antibiotic therapy.
A standard (6-mm diameter) flexible fiberoptic bronchoscope (Olympus) with internal work channel was used during all bronchoscopies. The bronchoscope was advanced to a segment or subsegment bronchus. In place, a double-lumen catheter with a PSB and a distal polyethylene glycol occlusion (microbiology specimen brush, Microvasive Inc, Medi-tech, Watertown, Mass) was inserted through the work channel. In the bronchus, the polyethylene glycol plug was discharged and the PSB was everted. After brushing and retraction, the PSB was aseptically cut into a tube with exactly 1 ml of physiologic saline solution. The BAL was first done with 10 to 15 ml of sterile water for Legionella culture, and after that with 100 to 150 ml of physiologic saline solution in 30-ml aliquots. Finally, material from a nonsterile brush (NSB) was prepared with Gram stain.