P22 Yield of Microbiology Samples Taken During Bronchoscopy Performed For the Diagnosis of Lung Cancer
Introduction and Objectives Previous studies have suggested that bronchial lavage does not improve the yield of bronchoscopy if tumour is visible and biopsies and brushings are taken (1). However, no assessment was made of the microbiological yield from lavage samples. The aim of this study was to determine the prevalence and nature of positive bronchial culture in patients presenting with lung cancer.
Methods A retrospective review was conducted of the case notes of all patients between November 2009 and May 2012 who underwent a flexible bronchoscopy for the diagnosis of lung cancer, and were determined by the operator to have either a definite or probable visible malignancy. In all patients BAL had been performed and sent for microbiological investigation in addition to cytology. Type and frequency of culture were analysed, along with the relationship between culture and lung cancer histology, stage, and the performance status of the patient.
Results 95 patients underwent a flexible bronchoscopy at the time of diagnosis within the time period. The majority were male (62%) with an average age of 70 years (range 31–91). Culture was positive in 37.7% of samples. 32.5% of these organisms were gramme negative (mostly Pseudomonas spp. and coliform bacilli), 20.9% gramme positive (S. pneumoniae, S. aureus, MRSA), 41.9% Candida spp., and 4.7% Aspergillus spp. The predominant form of lung cancer was non-small cell (56%, of which 58.4% were squamous), the majority of patients having advanced disease (92% stage IIIA-IV) with a good performance status (55.8% PS 0–1). Patient characteristics, tumour histology, or stage were not significantly different in patients with, or without, positive culture.
Conclusions This study has shown that more than a third of patients investigated for lung cancer had evidence of bronchial colonisation with potentially pathogenic bacteria at the time of diagnosis. This suggests that lavage ought to remain a routine aspect of bronchoscopy for cancer, as identification of bacteria at this early stage might be used to guide the choice of effective antibiotics for the treatment of subsequent pulmonary infections.
Waine DJ et al. Am J Resp Crit Care Med 2004; 169(7):A332.