Comparison of the Results of Bronchoalveolar Lavage Culture and Endotracheal Aspirate Culture in Intubated Critically Ill COVID-19 Patients

Introduction: Secondary pneumonia is frequently seen in COVID-19 cases followed up intubated, and high mortality rates can be observed. Isolation of the agent with bronchoalveolar lavage (BAL) culture or endotracheal aspirate (ETA) culture may increase the success of treatment. This study aimed to retrospectively analyze the results of BAL and ETA cultures in intubated COVID-19 cases.

Methods: We routinely apply BAL culture with bronchoscopy or ETA culture within the first 48 hours after intubating. We retrospectively screened cases who underwent BAL and ETA. They were divided into two groups: Group B and E. Evaluated parameters were compared in both groups.

Results: Demographic data and blood test results were similar in both groups. Intensive care unit (ICU) and intubation durations, and culture positivity were statistically significantly higher in Group B. Although not statistically significant, the mortality rate was higher in Group E. The most growth microorganisms were Candida species.

Conclusion: Mortality rates were consistent with the literature. Since the microorganism isolation rate is higher with BAL and antimicrobial treatment is applied more effectively; early deaths were prevented and stay periods were prolonged. In contrast, these durations were shorter in the ETA group due to higher mortality. In intubated COVID-19 cases, a more effective treatment process can be carried out by clearing the airway with fiberoptic bronchoscopy and by specifically planning the treatment according to the BAL culture. This may have a positive effect on prognosis and mortality.

Study Overview

• Status: Completed
• Conditions: Critical Illness; COVID-19 Pneumonia; Bronchoalveolar Lavage
• Intervention / Treatment: Procedure: Bronchoalveolar lavage; Procedure: endotracheal aspirate culture

• Study Type: Observational
• Enrollment (Actual): 67

Contacts and Locations

Study Locations

• Turkey
  • Istanbul, Turkey, 34768
    • Hisar Intercontinental Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

The patients who were intubated due to COVID 19 in our reanimation unit between January 2021 and December 2021 and underwent BAL or ETA analysis were retrospectively scanned from the hospital information management system and patient files.

Description

Inclusion Criteria:

• Intubated COVID-19 patients
• Above 18 years old patients

Exclusion Criteria:

• Non COVID-19 patients
• Non intubated COVID-19 patients
• Below 18 years old patients

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Group B (bronchoalveolar lavage); Patients who underwent BAL* were named Group B * BAL: bronchoalveolar lavage	Procedure: Bronchoalveolar lavage; In cases approved for bronchoscopy, bronchoalveolar lavage was performed and culture analysis was performed.; Other Names: Bronchoalveolar lavage culture; fiberoptic bronchoscopy
Group E (endotracheal aspirate); Patients who received ETA** were named Group E. ** ETA: Endotracheal aspirate	Procedure: endotracheal aspirate culture; In cases where consent for bronchoscopy could not be obtained, tracheal secretions were aspirated and culture analysis was performed.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Culture positivity	Significantly higher microbiological culture growth rate was obtained in Group B	1 years
Length of stay in intensive care unit	Significantly higher duration of stay in intensive care unit was found in Group B	1 years
Duration of intubation	Significantly higher duration of stay intubated was observed in Group B	1 years
Mortality	Mortality rate was higher in Group E. But not statistically significant.	1 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Microorganism	The most growing microorganism in both groups was the Candida species.	1 years

Collaborators and Investigators

• Sponsor: Basri Cakiroglu
• Investigators: Principal Investigator: Hasan Huseyin Kilic, Hisar Intercontinental Hospital

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2021
• Primary Completion (Actual): December 31, 2021
• Study Completion (Actual): May 31, 2022

Study Registration Dates

• First Submitted: June 2, 2022
• First Submitted That Met QC Criteria: June 2, 2022
• First Posted (Actual): June 3, 2022

Study Record Updates

• Last Update Posted (Actual): June 3, 2022
• Last Update Submitted That Met QC Criteria: June 2, 2022
• Last Verified: June 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Pneumonia, Viral; Pneumonia; Lung Diseases; Disease Attributes; COVID-19; Critical Illness; Molecular Mechanisms of Pharmacological Action; Chelating Agents; Sequestering Agents; Dimercaprol
• Other Study ID Numbers: HisarIH

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No