The detection of Mycobacterium tuberculosis (MTB) in the intensive care unit (ICU) presents several challenges, mainly associated to the clinical state of the patient. The presence of HIV infection further aggravates this scenario, requiring a reliable collection method, with better performance in the microbiological/molecular techniques to be used. We evaluated the performance of two methods for sample collection, mini bronchoalveolar lavage (Mini-BAL) and endotracheal aspirate (ETA), for diagnosis of pulmonary tuberculosis (PTB) in critically ill patients. This prospective study involved 26 HIV positive ICU internalized patients, with presumptive PTB who required mechanical ventilation. Two samples were obtained prospectively from 26 HIV ICU patients with presumptive PTB by Mini-BAL and ETA. The samples were processed for smear microscopy, Löwenstein-Jensen medium and the BACTEC Mycobacteria Growth Indicator Tube 960 system®. We define as confirmed PTB patients with positive MTB culture. Furthermore, all samples obtained through the Mini-BAL were analyzed by Xpert® MTB/RIF. Our results demonstrated that the respiratory samples obtained by Mini-BAL were able to increase MTB detection in critically ill patients with presumptive PTB. The Mini-BAL allowed 30% increased recovery and guaranteed enough sample volume for processing in all methods. In addition, the larger volume of the samples obtained with this technique enabled the Xpert® MTB/RIF molecular test for diagnosis of TB. The Mini-BAL showed be an acceptable alternative to ETA in this population, since these critically ill and often-immunocompromised patients are more likely to develop complications related to invasive procedures.

中文翻译：

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微型支气管肺泡灌洗液在危重患者肺结核诊断中的作用


在重症监护病房 (ICU) 中检测结核分枝杆菌 (MTB) 存在一些挑战，主要与患者的临床状态有关。 HIV 感染的存在进一步加剧了这种情况，需要可靠的收集方法，并且所使用的微生物/分子技术具有更好的性能。我们评估了两种样本采集方法的性能，即迷你支气管肺泡灌洗 (Mini-BAL) 和气管内抽吸 (ETA)，用于诊断危重患者肺结核 (PTB)。这项前瞻性研究涉及 26 名 HIV 阳性 ICU 住院患者，这些患者推测患有 PTB，需要机械通气。通过 Mini-BAL 和 ETA 前瞻性地从 26 名疑似 PTB 的 HIV ICU 患者中获取了两个样本。样本经过涂片显微镜检查、Löwenstein-Jensen 培养基和 BACTEC 分枝杆菌生长指示管 960 system® 处理。我们将 MTB 培养呈阳性的确诊 PTB 患者定义为。此外，通过 Mini-BAL 获得的所有样品均由 Xpert® MTB/RIF 进行分析。我们的结果表明，通过 Mini-BAL 获得的呼吸道样本能够提高疑似 PTB 危重患者的 MTB 检出率。 Mini-BAL 可将回收率提高 30%，并保证有足够的样品量用于所有方法的处理。此外，通过该技术获得的样本量更大，使得 Xpert® MTB/RIF 分子测试能够诊断结核病。在该人群中，Mini-BAL 被证明是 ETA 的可接受替代方案，因为这些病情危重且免疫功能低下的患者更有可能出现与侵入性操作相关的并发症。