..Among the patients, 33 had received antibiotic therapy and 21 did selleck screening library not receive antibiotic therapy before the pathogen identification procedures.Diagnostic procedureAll 54 patients had blood cultures and fiberoptic bronchoscopy-guided mini-BAL. We completed 37 mini-BAL procedures in patients with NIV support and 17 in intubated patients with mechanical ventilation support. No complications possibly related to bronchoscopy were reported.Microbiological identification rateAmong the 54 patients, pathogens were identified in 25 patients (46.3%) using mini-BAL, and in 6 patients (11.1%) using blood cultures (P < .01) (Figure (Figure3).3). When both blood cultures and mini-BAL were positive, they always identify the same organism. Bacteriological identification revealed a broad spectrum of bacteria (Table (Table2).

2). Among 28 identified pathogens, 23 wild-type resistance phenotype or had low levels of drug resistance and 5 were MDR.Figure 3Bacteriological identification blood cultures versus fiberoptic bronchoscope-guided distal protected small volume bronchoalveolar lavage (FODP mini-BAL). *P <0.05Table 2Bacteriological identification with FODP mini-BALTwenty-one patients had not received previous antibiotic therapy. Among these patients, we obtained bacteriological diagnoses for 16 patients (76.2%) using FODP mini-BAL and for 2 patients (9.5%) using blood cultures (Figure (Figure3).3). Thirty-three patients had received previous antibiotic therapy before the microbiological diagnostic procedure. We obtained identification for 9 patients (27.3%) using mini-BAL and for 4 patients (12.

1%) using blood cultures (Figure (Figure3).3). The relative risk of non-identification with previous antibiotic therapy versus without previous antibiotic therapy with FODP mini-BAL is 3.3 (95% confidence interval, 1.5 to 7.25).In the patients with bacteriological identification, we studied the effectiveness of the initial antibiotic therapy. With the broad-spectrum treatment of the study, three initial treatments were ineffective on the pathogen (M. tuberculosis, Escherichia coli BLSE, and L. pneumophila).In theory, if we used antibiotic treatment of severe community acquired pneumonia, Carfilzomib with combined Ceftriaxon/Levofloxacin, six initial treatments were ineffective (three P. aeruginosa, M. tuberculosis, E. coli BLSE, and L. pneumophila) and treatments were not optimum for three patients infected by Staphylococcus aureus.De-escalation rateWhen bacteriological identification was obtained, initial antibiotic therapy could be adapted to the antibiogram in 100% of cases.DiscussionTo our knowledge, this is the first study to focus on bacteriological diagnosis using FODP mini-BAL in HCAP patients admitted to an emergency department.