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Vol. 34. Issue 8.
Pages 388-393 (September 1998)
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Vol. 34. Issue 8.
Pages 388-393 (September 1998)
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Utilidad del lavado broncoalveolar en el paciente trasplantado renal con sospecha de infección respiratoria
Utility of bronchoalveolar lavage in the kidney transplant patient with suspicion of respiratory infection
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3594
L.A. Ruiz1, R. Gil, R. Zalacain, V. Cabriada, J.L. Llorente
Servicio de Neumología. Hospital de Cruces. Baracaldo. Vizcaya
J. Barrón*, A. García-Riego**
* Servicio de Microbiología. Hospital de Cruces. Baracaldo. Vizcaya
** Sección de Citología. Hospital de Cruces. Baracaldo. Vizcaya
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El objetivo de nuestro estudio ha sido valorar de forma retrospectiva la rentabilidad diagnóstica del lavado broncoalveolar en aquellos pacientes con trasplante renal en los que se sospechó una infección respiratoria grave o presentaron una falta de respuesta al tratamiento antibiótico administrado empíricamente.

Se han incluido todos los lavados broncoalveolares realizados a pacientes con trasplante renal y sospecha de infección respiratoria entre el 1 de enero de 1988 y el 31 de julio de 1996. El lavado broncoalveolar se realizó según procedimiento estándar, remitiéndose muestras para estudios citológicos y bacteriológicos.

Se estudiaron a 33 pacientes con una edad media de 48,5 años; estaban recibiendo tratamiento inmunodepresor; el tiempo medio postrasplante fue de 320 días. Treinta y uno recibieron tratamiento con antibiótico previo a la realización de la prueba.

El lavado broncoalveolar fue positivo en 21/33 pacientes (64%), identificándose a 22 patógenos (6 Pneumocystis carinii, 4 citomegalovirus, 3 Mycobacterium tuberculosis, 2 Aspergillus fumigatus, 2 herpes simple tipo I, un Streptococcus pneumoniae, un Staphylococcus aureus, un Streptococcus mitis, una Legionelia pneumophila y una Legionelia longbeachae). El lavado broncoalveolar fue negativo en 12 pacientes, de los que a ocho se les diagnosticó de sospecha de infección bacteriana, a tres de edema agudo de pulmón y a uno de infarto pulmonar.

En función de los resultados obtenidos se pudo cambiar el tratamiento en 20 pacientes (61%); en 19 (58%) por hallazgo de un patógeno no sospechado y en uno porque se pudo simplificar.

El lavado broncoalveolar es una técnica que ofrece una alta rentabilidad (64%) en el estudio de los pacientes con trasplante renal y sospecha de infección respiratoria, siendo de utilidad en el tratamiento de este tipo de pacientes debido a que una alta proporción de los mismos (19/33) estaban infectados por patógenos no cubiertos con el tratamiento empírico.

Palabras clave:
Lavado broncoalveolar
Infección respiratoria en trasplantados renales
Trasplante renal

In this retrospective study we aimed to assess the diagnostic yield of bronchoalveolar lavege (BAL) in kidney transplant patients who were suspected of having severe respiratory infection or in whom empirical antibiotic treatment had failed.

All BAL procedures performed on kidney transplanted patients suspected of having respiratory infections between January 1, 1988 and July 31, 1996 were analyzed. BAL was carried out in the Standard way and samples were sent for cytologic and bacteriologic study.

Thirty-three patients with a mean age of 48.5 years were enrolled. All had been receiving inmunosuppressive treatment and the mean time following transplantation was 320 days. Thirty-one had received antibiotic treatment before BAL.

BAL was positive for 21 of the 33 patients (64%). Twentytwo pathogens were identified: 6 Pneumocystis carinii, 4 Cytomegalovirus, 3 Mycobacterium tuberculosis, 2 Aspergillus fumigatus, 2 Herpes simplex type I, 1 Streptococcus pneumoniae, 1 Staphylococcus aureus, 1 Streptococcus mitis, 1 Legionella pneumophila, 1 Legionelia longbeachae. BAL was negative for 12 patients, of whom 8 were tentatively diagnosed of bacterial infection, 3 of acute pulmonary edema and one of pulmonary infarction. Based on the results, therapy was changed for 20 patients (61%), 19 (58%) because an unsuspected pathogen was identified and 1 because treatment could be simplified.

The diagnostic yield of BAL is high (64%) in kidney transplant patients suspected of respiratory infection and is useful for managing such cases, as evidenced by the fact that a high proportion (19/33) of our patients were infected by pathogens not covered by empirical treatment.

Key words:
Bronchoalveolar lavage
Respiratory infection after kidney transplants
Kidney transplant
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Copyright © 1998. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
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