Bronchoscopic Microbial Diagnosis in Non-Responding & Non-Resolving Pneumonia

Abstract

Introduction: Pneumonia is a common and potentially serious illness associated with considerable morbidity and mortality, especially in the elderly and those with notable comorbidities. More than 100 microbes (bacteria, viruses, fungi, and parasites) can cause pneumonia. In hospitalized community-acquired pneumonia (CAP), 40% are non-responding CAP. The reliability of using bronchoscopic procedures when compared with sputum cultures, routinely processed bronchoscopic specimens demonstrate improved sensitivity.    

Aims & Objectives: Isolation of a responsible microbe causing respiratory infection in non-responding & non- resolving pneumonia.

Place and duration of study: This Study was conducted at the Department of Pulmonology Shaikh Zayed Medical Complex, Lahore from 01-01-2018 to 31-12-2019.

Material & Methods: Retrospective analysis of 109 bronchoscopic procedures conducted in patients with NonResponding & Non-Resolving Pneumonia with a fiberoptic bronchoscope over two years (01-01-2018 to 3112-2019).

Results: One hundred nine (109) procedures were done in patients with non-responding and resolving Pneumonia. Bronchial washing microbiology yielded results in 71 (65.1%) patients. Pseudomonas aeruginosa was the most frequent organism and was isolated in 30 (42.3%) patients; Klebsiella pneumoniae was found in 23 (32.4%) patients. Other organisms included Staphylococcus aureus (22.5%), Acinetobacter baumanni (14.1%), Escherichia coli (11.3%), Streptococcus pneumoniae (11.3%), Stenotrophomonas maltophilia (4.2%), Haemophilus influenzae (2.8%), Enterococcus (1.4%) and Mycobacterium tuberculosis (4.2%).

Conclusion: Pseudomonas aeruginosa and Klebsiella pneumoniae are the most common isolated organisms in patients with non-responding and non-resolving Pneumonia. Bronchoscopy is an extremely useful tool for sample collection among non-responding & non-resolving pneumonia and making the correct microbiological diagnosis.