Bronchoscopy in the diagnosis of respiratory infections

In recent years, several factors have altered the spectrum of respiratory infections and their likelihood of response to empiric treatment. Altered microbial resistance has led to the possible need for specific etiologic diagnosis in some hospital-acquired infections in the normal host. In the immune-compromised host, the spectrum of atypical presentations and unusual organisms limits the clinician's ability to choose effective empiric therapies. In the normal host, bronchoscopic diagnosis seems to be most useful in the groups with severe community-acquired pneumonia or poor response to therapy for community-acquired pneumonia. The group of patients with ventilator-associated pneumonia has been well-researched and the bronchoscopic techniques tend to show increased sensitivity over other diagnostic means, but this has not been proven to alter morbidity, mortality, or cost effectiveness. The immune-compromised host is commonly infected by organisms not easily diagnosed by other means and is thus unable to be treated empirically. Bronchoscopic diagnostic techniques play a larger and more clearly delineated role in these populations, including the patient populations with solid organ transplants, bone marrow transplants, and AIDS.