The role of bacterial cultures from bronchoscopy washings in AIDS related patients

The clinical significance of bronchoscopy washing cultures for bacteria had been questioned before the era of the acquired immune deficiency syndrome (AIDS), and the procedure was felt to be misleading more than helpful. Little has been mentioned of its utility in AIDS patients undergoing fiberoptic bronchoscopy. The correlation of these cultures was retrospectively reviewed for 30 bronchoscopies performed in 26 patients with advanced AIDS related illnesses. Normal respiratory flora was the most common finding in 14/28 (50%) of the cultures submitted, followed by Staphylococcus aureus in 7/28 (25%). Correlating chest radiographs with culture results revealed that in only five cases were cultures definitely or possibly relevant. All five had radiographic changes compatible with bacterial processes, and clinical findings suggestive of disease. The routine submission of bronchoscopy washings for bacterial culture in patients with HIV associated disease should be discouraged without clinical and radiologic correlation.