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Bacterial burden and bronchoalveolar cytokines in mechanically ventilated patients with suspected pneumonia

Introduction

Cytokines play an important role in pulmonary host defense. However, nonuniform findings have been reported about the correlation between bronchoalveolar bacterial burden and the lung inflammatory response.

Objective

The aim of the present study was to evaluate the relationship between bronchoalveolar cytokine expression and bacterial burden in mechanically ventilated patients with suspected pneumonia.

Methods

Mechanically ventilated patients with suspected pneumonia admitted to the ICU from November 2004 to January 2006 were prospectively enrolled. Fiberoptic bronchoalveolar lavage (BAL) was performed with 150 ml sterile isotonic saline in three aliquots of 50 ml; local anesthetic was not used. BAL samples for microbiologic quantitative cultures and BAL cytokines – IL-6, IL 8, TNFα, granulocyte colony-stimulating factor (G-CSF) and granulocyte–monocyte colony-stimulating factor (GM-CSF) – were measured.

Results

Fifty-nine patients were included, and most of the patients (79.7%) had prior antibiotic therapy. Twenty-two patients (37.2%) had a positive bacterial culture defined as a diagnostic threshold >10,000 colony-forming units/ml. Only the concentration of TNFα was significantly higher in the group of patients with positive BAL (Table 1).

Table 1 (abstract P90)

Conclusion

(1) There is a significant correlation between TNFα in BAL fluid and the lung bacterial burden. (2) BAL TNFα is an early marker of pneumonia in mechanical ventilated patients despite prior antibiotic therapy.

Clinical implication

Cytokine measurements in BAL may be a diagnostic tool to support the diagnosis of the initial phase of pneumonia.

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García, Á.E., Robles, A.R., de Baranda, A.S. et al. Bacterial burden and bronchoalveolar cytokines in mechanically ventilated patients with suspected pneumonia. Crit Care 11, P90 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5250

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Keywords

  • Pneumonia
  • Local Anesthetic
  • Bronchoalveolar Lavage
  • Cytokine Expression
  • Isotonic Saline