Fungal Diagnostic Stewardship in Bronchoscopy Specimens for Immunocompetent Patients in the Intensive Care Unit

Area of Science:

• Medical Microbiology
• Critical Care Medicine
• Pulmonology

Background:

• Respiratory tract infections are common in intensive care units (ICUs).
• Extensive microbiological testing is often performed on respiratory samples from ICU patients.
• The diagnostic yield of fungal cultures in immunocompetent ICU patients is not well-established.

Purpose of the Study:

• To evaluate the diagnostic utility of fungal smears and cultures from bronchial lavage and wash specimens.
• To determine if fungal testing of respiratory samples impacts patient care in immunocompetent ICU patients.

Main Methods:

• A prospective study enrolled 112 immunocompetent adult patients in medical and surgical ICUs.
• Fungal smears and cultures were performed on 131 bronchoscopic and 31 bronchoalveolar lavage specimens.
• The impact of fungal culture results on patient management was assessed.

Main Results:

• Fungal cultures were held for a total of 4680 culture-days.
• Only two results changed patient therapy.
• In both instances, alternative routine tests provided the same diagnostic information prior to fungal culture results.

Conclusions:

• Fungal culture of respiratory tract specimens provides no additional diagnostic value in immunocompetent, critically ill patients.
• Routine fungal culture of respiratory specimens should be discontinued in this patient group.
• Clinical decisions should rely on more timely diagnostic methods.