Skip to main content
Top

Open Access 08-04-2024 | Expectoration | Research

The agreement between bronchoalveolar lavage, bronchial wash and sputum culture: a retrospective study

Authors: Anne-Eva Post, Erik Bathoorn, Douwe F. Postma, Dirk-Jan Slebos, Onno W. Akkerman

Published in: Infection

Login to get access

Abstract

Purpose

Bronchoalveolar lavage is commonly used in clinical practice for unresolved pneumonia. However, bronchoalveolar lavage is not suitable for all patients as it is an invasive procedure and can worsen oxygenation. The diagnostic value of bronchial wash and sputum has been debated extensively over the years. In this study, we aim to compare the diagnostic value in several pathogens of bronchoalveolar lavage and bronchial wash, and secondarily bronchoalveolar lavage and sputum.

Methods

We retrospectively included all adult patients in our hospital who underwent bronchoalveolar lavage, bronchial wash, and where sputum sampling was done between January 1st of 2018 and December 31st of 2021. The intraclass correlation coefficient was computed for the three tests.

Results

In total, 308 patients were included. We found a level of correlation of 0.819 and 0.865, respectively, between bronchoalveolar lavage and bronchial wash for two pathogens: Staphylococcus aureus and Pseudomonas aeruginosa. For Stenotrophomonas maltophilia and Aspergillus fumigatus, we found an intraclass correlation coefficient of 0.568 and 0.624, respectively. Between bronchoalveolar lavage and sputum, we found varying levels of agreement.

Conclusion

Our study shows reasonably well agreement levels between bronchoalveolar lavage and bronchial wash, suggesting that bronchial wash could potentially be an alternative to bronchoalveolar lavage.
Literature
2.
go back to reference Murdoch DR, O’Brien KL, Scott JAG, Karron RA, Bhat N, Driscoll AJ, et al. Breathing new life into pneumonia diagnostics. J Clin Microbiol. 2009;47:3405–8.CrossRefPubMedPubMedCentral Murdoch DR, O’Brien KL, Scott JAG, Karron RA, Bhat N, Driscoll AJ, et al. Breathing new life into pneumonia diagnostics. J Clin Microbiol. 2009;47:3405–8.CrossRefPubMedPubMedCentral
3.
go back to reference Holter JC, Müller F, Bjørang O, Samdal HH, Marthinsen JB, Jenum PA, et al. Etiology of community-acquired pneumonia and diagnostic yields of microbiological methods: a 3-year prospective study in Norway. BMC Infect Dis. 2015;15:64–75.CrossRefPubMedPubMedCentral Holter JC, Müller F, Bjørang O, Samdal HH, Marthinsen JB, Jenum PA, et al. Etiology of community-acquired pneumonia and diagnostic yields of microbiological methods: a 3-year prospective study in Norway. BMC Infect Dis. 2015;15:64–75.CrossRefPubMedPubMedCentral
4.
go back to reference Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27–72.CrossRefPubMed Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27–72.CrossRefPubMed
5.
go back to reference Ewig S, Schlochtermeier M, Goöke N, Niederman MS. Applying sputum as a diagnostic tool in pneumonia: Limited yield, minimal impact on treatment decisions. Chest. 2002;121:1486–92.CrossRefPubMed Ewig S, Schlochtermeier M, Goöke N, Niederman MS. Applying sputum as a diagnostic tool in pneumonia: Limited yield, minimal impact on treatment decisions. Chest. 2002;121:1486–92.CrossRefPubMed
6.
go back to reference Zhang R, Wu Y, Deng G, Deng J. Value of sputum Gram stain, sputum culture, and bronchoalveolar lavage fluid Gram stain in predicting single bacterial pathogen among children with community-acquired pneumonia. BMC Pulm Med. 2022;22:427–32.CrossRefPubMedPubMedCentral Zhang R, Wu Y, Deng G, Deng J. Value of sputum Gram stain, sputum culture, and bronchoalveolar lavage fluid Gram stain in predicting single bacterial pathogen among children with community-acquired pneumonia. BMC Pulm Med. 2022;22:427–32.CrossRefPubMedPubMedCentral
7.
go back to reference Peng Z, Zhou J, Tian L. Pathogenic characteristics of sputum and bronchoalveolar lavage fluid samples from patients with lower respiratory tract infection in a large teaching hospital in China: a retrospective study. BMC Pulm Med. 2020;20:233–9.CrossRefPubMedPubMedCentral Peng Z, Zhou J, Tian L. Pathogenic characteristics of sputum and bronchoalveolar lavage fluid samples from patients with lower respiratory tract infection in a large teaching hospital in China: a retrospective study. BMC Pulm Med. 2020;20:233–9.CrossRefPubMedPubMedCentral
8.
go back to reference Torres A, Cilloniz C, Niederman MS, Menéndez R, Chalmers JD, Wunderink RG, et al. Pneumonia. Nat Res. 2021;7:25–52. Torres A, Cilloniz C, Niederman MS, Menéndez R, Chalmers JD, Wunderink RG, et al. Pneumonia. Nat Res. 2021;7:25–52.
9.
go back to reference Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. The Lancet. 2015;386:1097–108.CrossRef Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. The Lancet. 2015;386:1097–108.CrossRef
10.
go back to reference Baselskin VS, Wunderink RG. Bronchoscopic diagnosis of pneumonia. Clin Microbiol Rev. 1994;7:533–58.CrossRef Baselskin VS, Wunderink RG. Bronchoscopic diagnosis of pneumonia. Clin Microbiol Rev. 1994;7:533–58.CrossRef
11.
go back to reference Sanchez Nieto JM, Carillo AA. The role of bronchoalveolar lavage in the diagnosis of bacterial pneumonia. Clin Microbio Infect Dis. 1995;14:839–50. Sanchez Nieto JM, Carillo AA. The role of bronchoalveolar lavage in the diagnosis of bacterial pneumonia. Clin Microbio Infect Dis. 1995;14:839–50.
12.
go back to reference Patrucco F, Gavelli F, Ravanini P, Daverio M, Statti G, Castello LM, et al. Use of aninnovative and non-invasive device for virologic sampling of cough aerosols in patients with community and hospital acquired pneumonia: A pilot study. J Breath Res. 2019;13:1–8.CrossRef Patrucco F, Gavelli F, Ravanini P, Daverio M, Statti G, Castello LM, et al. Use of aninnovative and non-invasive device for virologic sampling of cough aerosols in patients with community and hospital acquired pneumonia: A pilot study. J Breath Res. 2019;13:1–8.CrossRef
13.
go back to reference Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63:61–111.CrossRef Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63:61–111.CrossRef
14.
go back to reference Martinu T, Koutsokera A, Benden C, Cantu E, Chambers D, Cypel M, et al. International Society for Heart and Lung Transplantation consensus statement for the standardization of bronchoalveolar lavage in lung transplantation. J Heart Lung Transplant. 2020;39:1171–90.CrossRefPubMedPubMedCentral Martinu T, Koutsokera A, Benden C, Cantu E, Chambers D, Cypel M, et al. International Society for Heart and Lung Transplantation consensus statement for the standardization of bronchoalveolar lavage in lung transplantation. J Heart Lung Transplant. 2020;39:1171–90.CrossRefPubMedPubMedCentral
17.
go back to reference Horan TC, Andrus M, Dudeck MA, Atlanta M, Background G. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. AM J Infect Control. 2008;36:309–32.CrossRefPubMed Horan TC, Andrus M, Dudeck MA, Atlanta M, Background G. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. AM J Infect Control. 2008;36:309–32.CrossRefPubMed
18.
go back to reference Zhang CYK, Ahmed M, Huszti E, Levy L, Hunter SE, Boonstra KM, et al. Utility of bile acids in large airway bronchial wash versus bronchoalveolar lavage as biomarkers of microaspiration in lung transplant recipients: a retrospective cohort study. Respir Res. 2022;23:219–31.CrossRefPubMedPubMedCentral Zhang CYK, Ahmed M, Huszti E, Levy L, Hunter SE, Boonstra KM, et al. Utility of bile acids in large airway bronchial wash versus bronchoalveolar lavage as biomarkers of microaspiration in lung transplant recipients: a retrospective cohort study. Respir Res. 2022;23:219–31.CrossRefPubMedPubMedCentral
19.
go back to reference Keith Pinckard J, Kollef M, Michael DW. Culturing bronchial washings obtained during bronchoscopy fails to add diagnostic utility to culturing the bronchoalveolar lavage fluid alone. Diagn Microbiol Infect Dis. 2002;43:99–105.CrossRefPubMed Keith Pinckard J, Kollef M, Michael DW. Culturing bronchial washings obtained during bronchoscopy fails to add diagnostic utility to culturing the bronchoalveolar lavage fluid alone. Diagn Microbiol Infect Dis. 2002;43:99–105.CrossRefPubMed
20.
go back to reference Kim YW, Kwon BS, Lim SY, Lee YJ, Cho YJ, Yoon HI, et al. Diagnostic value of bronchoalveolar lavage and bronchial washing in sputum-scarce or smear-negative cases with suspected pulmonary tuberculosis: a randomized study. Clin Microbiol Infect. 2020;26:911–6.CrossRefPubMed Kim YW, Kwon BS, Lim SY, Lee YJ, Cho YJ, Yoon HI, et al. Diagnostic value of bronchoalveolar lavage and bronchial washing in sputum-scarce or smear-negative cases with suspected pulmonary tuberculosis: a randomized study. Clin Microbiol Infect. 2020;26:911–6.CrossRefPubMed
21.
go back to reference Tasbakan MS, Gurgun A, Basoglu OK, Ekren PK, Pullukcu H, Bacakoglu F. Comparison of bronchoalveolar lavage and mini-bronchoalveolar lavage in the diagnosis of pneumonia in immunocompromised patients. Respiration. 2011;81:229–35.CrossRefPubMed Tasbakan MS, Gurgun A, Basoglu OK, Ekren PK, Pullukcu H, Bacakoglu F. Comparison of bronchoalveolar lavage and mini-bronchoalveolar lavage in the diagnosis of pneumonia in immunocompromised patients. Respiration. 2011;81:229–35.CrossRefPubMed
Metadata
Title
The agreement between bronchoalveolar lavage, bronchial wash and sputum culture: a retrospective study
Authors
Anne-Eva Post
Erik Bathoorn
Douwe F. Postma
Dirk-Jan Slebos
Onno W. Akkerman
Publication date
08-04-2024
Publisher
Springer Berlin Heidelberg
Published in
Infection
Print ISSN: 0300-8126
Electronic ISSN: 1439-0973
DOI
https://doi.org/10.1007/s15010-024-02238-5
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.