The role of BAL in pneumonia: a single-center retrospective study in the last year.

Le résumé fourni par la source

Pneumonia is a common respiratory disease and it is a major cause of hospitalization. Accurate diagnosis is critical for identifying specific etiologic agents and optimizing therapy. The bronchoalveolar lavage (BAL) is not considered a routine examination, preferring a diagnostic approach with less invasive methods (blood cultures, sputum culture, urinary antigen test) and reserving BAL for patients at risk for resistant pathogens or who are not responding to treatment. This analysis focuses on the use of BAL in the etiological diagnosis of pneumonia, identifying patient characteristics that may benefit from performing BAL. The study cohort includes patients with pneumonia that received care in the respiratory disease unit of IRCCS Policlinico San Matteo Foundation in Pavia from October 2023 to October 2024. On a total of 302 patients, of which 159 males and 143 females, 85 BAL were performed, with 41 of them resulting in microbiological isolation. 20% of patients with positive BAL had already received a previous course of antibiotics, 40% were over 60 years of age and 29% required HFNC as respiratory support. The average length of hospital stay in patients with positive BAL was 20 days. The most frequently isolated pathogens were: Candida 8, Aspergillus 3, viruses 6, Gram-negative bacteria 14 (P. aeruginosa, H. influenzae, K. pneumoniae, Serratia, E. coli, Stenotrophomonas), Gram-positive bacteria 8 (S. aureus, S. pneumoniae, Enterobacter, E. faecalis, Corynebacterium), mycobacteria 1. Our research is a starting point for highlighting the need for a personalized approach to adequately select patients in whom the performance of BAL can improve diagnostic accuracy and optimize therapeutic strategies.

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