BRONCHOSCOPY IN THE DIAGNOSIS AND THERAPY OF NOSOCOMIAL PNEUMONIA

Background . The aim of our study was to evaluate the role of bronchoscopy in the diagnosis and treatment of hospital pneumonias by microbiological cultures obtained from bronchial aspirates. Methods . We included all patients treated for hospital pneumonias during 1999 in General Hospital Celje (Division of cardiology and pulmonary medical care, internal and surgical intensive care unit) in whom bronchoscopy was performed. Only the patients with obtained microbiological cultures (isolation and bacterial sensitivity to antibiotics) were studied. Results . We performed 112 bronchoscopies. Sixty-nine (62%) patients were males and 43 (38%) of female. Microbiological cultures were positive in 95 (85%) and negative in 17 (15%) specimens. Mortality rate was 32% and average length of stay was 14 days. The most frequently isolated bacteria was Pseudomonas aeruginosa (20 patients – 26%), followed by methicillin sensitive Staphylococcus aureus – MSSA in 14 patients. E. coli was present in 14 cultures and Streptococcus pneumoniae in 12 patients. Methicillin resistant Staphylococcus aureus – MRSA was found in 10 patients. Blood and central venous catheter clutures were positive in 10 patients. The same bacteria were also isolated in other specimens in 26 patients. Conclusions . Bronchoscopy is an important aid in diagnosing hospital pneumonias. In high percentage it provides microbiological evaluation of bronchial aspirate, and has major impact in selection of an appropriate antibiotic treatment.