Bronchoalveolar lavage (BAL)

Routine ICU BAL

• Routine culture - yes
• Myco-bacterial culture - optional
• Fungal culture - on request
• Aspergillus Antigen - on request
• Legionella culture - on request
• Nocardia culture - on request
• Full Resp Panel PCR - optional
• PJP PCR - on request
• CMV PCR - no
  

Chest Unit BAL

• Routine culture - yes
• Myco-bacterial culture - yes
• Fungal culture - on request
• Aspergillus Antigen - on request
• Legionella culture - on request
• Nocardia culture - on request
• Full Resp Panel PCR - no
• PJP PCR - on request
• CMV PCR - no

Immunocompromised BAL

• Routine culture - yes
• Myco-bacterial culture - yes
• Fungal culture - yes
• Aspergillus Antigen - optional
• Legionella culture - optional
• Nocardia culture - on request
• Full Resp Panel PCR - optional
• PJP PCR - optional
• CMV PCR - optional

The following are also available for certain complex / immunocompromised patients on discussion with Microbiology medical team:

• Multiplex PCR panel (BioFire FilmArray® pneumonia / ventilator-associated pneumonia (VAP) panel) with multiple bacterial, viral and antibiotic resistance gene targets (performed in house)
• Pan fungal PCR (reference laboratory test)

Sample type

• Bronchoalveolar Lavage (BAL) or Bronchoalveolar Washings / Brushings / Aspirates; must be obtained by skilled personnel with appropriate protection / isolation facilities
  
• Transbronchial / Lung Biopsy Samples

Specimen requirements

Send in a sterile universal container

Minimum volume

• Routine culture - 1ml
• Mycobacterial (TB) culture - 5ml ideally
• Further testing - 0.5-5ml, depending on number and type of tests required. Discuss with Microbiology medical staff.

Frequency of test

• Culture tests - daily
• Molecular tests - some molecular tests are run daily, others batched less frequently; urgent samples can usually be processed more quickly on discussion with Microbiology medical staff

Turnaround time

• Routine culture - 4 days
• Fungal culture - 21 days
• Mycobacteria culture - 8 weeks
• Legionella culture - 12 days
• Nocardia culture - 31 days
• Aspergillus antigen test - 2 days
• PCP PCR - 6 days
• BioFire Respiratory (Community-acquired) or Pneumonia (VAP) panels - <24 hours
• Mycology Reference Laboratory Fungal PCR TaT - 2 working days