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Improving the investigation of suspected respiratory disease
P178 The effect of BAL induced inflammation on nasal innate defence – reduction in experimental human pneumococcal carriage
  1. A D Wright1,
  2. J F Gritzfeld2,
  3. S El Batrawy3,
  4. L Roche4,
  5. A Collins3,
  6. S B Gordon2
  1. 1Comprehensive Local Research Network, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
  2. 2Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
  3. 3NIHR Biomedical Research Centre, Directorate of Infection and Immunity, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
  4. 4Royal Liverpool Hospital, Cheshire and Merseyside Comprehensive Local Research Network, Liverpool, UK

Abstract

Introduction and Objectives BAL causes pulmonary inflammation post procedure. It is not known if the inflammation affects the upper respiratory tract and nasal mucosa. We have developed an experimental human pneumococcal carriage (EHPC) platform. We wished to establish if prior bronchoscopy was associated with altered carriage rates in EHPC.

Methods Participants were screened for natural carriage of pneumococcus by nasal wash. Group A then proceeded to inoculation 7 days after initial screening whereas Group B underwent bronchoscopy with BAL prior to inoculation. Bronchoscopy with BAL was performed using fibre optic bronchoscope and instillation of 200 ml 0.9% saline in 50 ml aliquots followed by immediate manual aspiration via the working port of the bronchoscope. Participants were inoculated with 6B or 23F S pneumoniae (15 000–60 000 CFU/ml) within 14 days of bronchoscopy. Carriage was determined by the presence of pneumococci in nasal wash samples at 48 hr and/or 7 days post inoculation.

Results Thirty-seven participants were recruited, of which 19 proceeded to BAL prior to inoculation; 22 were inoculated with 6B and 15 with 23F. Baseline characteristics were not significantly different between Group A and B. Neither group had any symptoms at the time of inoculation. Both Group A and B were subdivided into 23F or those that received 6B. The inoculum dose was not significantly different between the BAL groups for either 23F or 6B. The mean length of time between bronchoscopy and inoculation was 10 days (±1). Carriage rates between Group A 6B and Group B 6B were significantly different (p=0.008); this difference was not seen between Group A 23F and Group B 23F. In adults challenged with SPN, carriage rates differ by type. In an experiment with high carriage rates, there was a significant decrease in carriage rates in subjects with preceding BAL.

Conclusions This study suggests that the inflammatory process caused by bronchoscopy with BAL, as highlighted in previous research, may influence innate mucosal defence. The inflammatory effect of bronchoscopy with BAL should be accounted for in future research allowing adequate time before performing interventions which may be affected.

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