Role of BAL in COVID-19 patients: a prospective multicenter study

L. Ciani*^a (Dr), J. Guiot^b (Prof), C. Ravaglia^c (Dr), V. Luzzi^d (Dr), L. Giuntoli^d (Dr), L. Gori^d (Dr), E. Benoit^b (Prof), E. Berillo^e (Dr), A. Morettini^f (Dr), C. Nozzoli^f (Dr), C. Nardi^g (Prof), A. Peired^h (Dr), F. Morecchiatoⁱ (Dr), F. Lavorini^f (Prof), M. Matucci Cerinic^f (Prof), R. Gian Mariaⁱ (Dr), S. Polliniⁱ (Dr), L. Maggi^e (Dr), F. Annunziato^e (Prof), V. Poletti^c (Prof), S. Tomassetti^d (Prof)

^a Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy, Firenze, ITALY ; ^b Repiratory Department, CHU Liège, Liège, Belgium., Liege, BELGIUM ; ^c Department of Respiratory and Chest Diseases GB Morgagni-Forli' Hospital (FC)/University of Bologna, Forlì, ITALY ; ^d Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy, Florence, ITALY ; ^e Department of Experimental and Clinical Medicine, University of Florence, Careggi University Hospital, Florence, Italy, Florence, ITALY ; ^f Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy., Florence, ITALY ; ^g Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy., Florence, ITALY ; ^h Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy., Florence, ITALY ; ⁱ Department of Experimental and Clinical Medicine, University of Florence, and Clinical Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy., Florence, ITALY

* lucaciani91@gmail.com

Introduction

The present study is part of DRAGON, a prospective multicentre European project aimed at improving the diagnosis of COVID-19.

Primary aim of this study is to evaluate BAL role in detecting coexisting infections. Secondary aims are BAL impact on the management of COVID patients, characteristics of BAL cellularity in COVID patients, safety of BAL in COVID patients and healthcare providers.

Methods

The study was carried out in 2021 at Careggi University Hospital in Florence, CHU of Liege and Morgagni Hospital Forlì.

The procedure was carried out in hospitalized COVID-19 patients. All patients underwent BAL for microbiological and cytological analysis. 115 patients were enrolled.

Results

Coinfections were detected in 35 out of 115 patients. Once coinfection was identified, patients received targeted antibiotic therapy and showed improvement in symptoms after initiation of antibiotic therapy.

In the remaining patients without coinfections, BAL negativity for other pathogens favored discontinuation of empiric antibiotic therapy.

In 34% of cases, we demonstrated the presence of lymphocytic alveolitis; in 49% of cases a neutrophilic alveolitis, and in 7% of cases a mixed lymphocytic/neutrophilic alveolitis.

BAL was positive for Sars-Cov-2 in all cases, 7 PCR nasal swab performed at the time of the BAL were negative.

No major adverse events were demonstrated in the 24 hours after BAL in enrolled patients. No patients required an increase intensity of care after the procedure.

There were no cases of infection among health care workers involved in bronchoscopic procedures.

Conclusion

Coinfections in COVID-19 patients are common. BAL is a safe tool to identify the presence of coinfections and help clinicians manage these patients correctly.

BAL cellularity in covid patients shows a predominance of neutrophils, particularly in cases of co-infection. Our data, in line with previous studies, suggests an earlier negativisation of nasopharyngeal swab compared to BAL

Disclosure of funding source(s): none