Kneidinger, Nikolaus; Warszawska, Joanna; Schenk, Peter; Fuhrmann, Valentin; Bojic, Andja; Hirschl, Alexander; Herkner, Harald; Madl, Christian; Makristathis, Athanasios:
Storage of bronchoalveolar lavage fluid and accuracy of microbiologic diagnostics in the ICU: a prospective observational study.
In: Critical Care
Introduction: Early initiation of appropriate antimicrobial treatment is a cornerstone in managing pneumonia. Because microbiologic processing may not be available around the clock, optimal storage of specimens is essential for accurate microbiologic identification of pathogenetic bacteria. The aim of our study was to determine the accuracy of two commonly used storage approaches for delayed processing of bronchoalveolar lavage in critically ill patients with suspected pneumonia. Methods: This study included 132 patients with clinically suspected pneumonia at two medical intensive care units of a tertiary care hospital. Bronchoalveolar lavage samples were obtained and divided into three aliquots: one was used for immediate culture, and two, for delayed culture (DC) after storage for 24 hours at 4 degrees C (DC4) and -80 degrees C (DC-80), respectively. Results: Of 259 bronchoalveolar lavage samples, 84 (32.4\%) were positive after immediate culture with 115 relevant culture counts (>= 10(4) colony-forming units/ml). Reduced (<10(4) colony-forming units/ml) or no growth of four and 57 of these isolates was observed in DC4 and DC-80, respectively. The difference between mean bias of immediate culture and DC4 (-0.035; limits of agreement, -0.977 to 0.906) and immediate culture and DC-80 (-1.832; limits of agreement, -4.914 to 1.267) was -1.788 +/- 1.682 (P < 0.0001). Sensitivity and negative predictive value were 96.5\% and 97.8\% for DC4 and 50.4\% and 75.4\% for DC-80, respectively; the differences were statistically significant (P < 0.0001). Conclusions: Bronchoalveolar lavage samples can be processed for culture when stored up to 24 hours at 4 degrees C without loss of diagnostic accuracy. Delayed culturing after storage at -80 degrees C may not be reliable, in particular with regard to Gram-negative bacteria.