Diagnostic value of telescoping plugged catheters in HIV-infected patients with pulmonary infiltrates

Abstract

To assess the diagnostic value of telescoping plugged catheters (TPC) in human immunodeficiency virus (HIV)-infected patients with pulmonary infiltrates (PI), we performed a prospective clinical study in 71 episodes of fever and PI in 66 HIV-infected patients (five patients had two different episodes of fever and PI). A control group of 12 HIV-infected patients with fever and normal chest roentgenogram was also studied. In all patients and prior to antibiotic treatment (except in mechanically ventilated patients), a TPC using quantitative cultures (cutoff point established at 10(3) CFU/ml) and a bronchoalveolar lavage (BAL) sampling were performed via fiberoptic bronchoscope. The overall incidence of bacterial pneumonia in the study group was 21 percent. The TPC cultures resulted in a microbiologic diagnosis of bacterial pneumonia in eight patients (11 percent) from the study group and in one patient (8 percent) from the control group. The TPC sensitivity in diagnosing bacterial infections was 53 percent and specificity was 76 percent. Negative predictive value was 85 percent and positive predictive value was 38 percent. By means of BAL, 35 episodes from the study group and two from the control group were diagnosed as nonbacterial or mycobacterial pulmonary infections. Considering TPC and BAL together, diagnosis was performed in 42 cases of PI (59 percent). Twenty percent (17/83) of HIV-infected patients suffered from bacterial colonization of their lower airways (a TPC culture greater than or equal to 10(3) CFU/ml without clinical evidence of bacterial infection). We conclude that the combined use of TPC and BAL may be useful in HIV-infected patients with PI, since this combined use allows the proper diagnosis of bacterial and nonbacterial infections, thereby increasing the overall diagnostic accuracy. To distinguish bacterial colonization from pulmonary infection in HIV-infected patients with PI, the cutoff point of quantitative cultures of TPC may be 10(4) CFU/ml.