{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:56:56Z","timestamp":1791478616994,"version":"4.3.4"},"reference-count":106,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T00:00:00Z","timestamp":1728432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["222919\/Z\/21\/Z"],"award-info":[{"award-number":["222919\/Z\/21\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["MR\/V006118\/1"],"award-info":[{"award-number":["MR\/V006118\/1"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014013","name":"RC Clinician Scientist Fellowship","doi-asserted-by":"publisher","award":["222919\/Z\/21\/Z"],"award-info":[{"award-number":["222919\/Z\/21\/Z"]}],"id":[{"id":"10.13039\/100014013","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014013","name":"RC Clinician Scientist Fellowship","doi-asserted-by":"publisher","award":["MR\/V006118\/1"],"award-info":[{"award-number":["MR\/V006118\/1"]}],"id":[{"id":"10.13039\/100014013","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The diagnosis of severe respiratory infections in intensive care remains an area of uncertainty and involves a complex balancing of risks and benefits. Due to the frequent colonisation of the lower respiratory tract in mechanically ventilated patients, there is an ever-present possibility of microbiological samples being contaminated by bystander organisms. This, coupled with the frequency of alveolar infiltrates arising from sterile insults, risks over-treatment and antimicrobial-associated harm. The use of bronchoscopic sampling to obtain protected lower respiratory samples has long been advocated to overcome this problem. The use of bronchoscopy further enables accurate cytological assessment of the alveolar space and direct inspection of the proximal airways for signs of fungal infection or alternative pathologies. With a growing range of molecular techniques, including those based on nucleic acid amplification and even alveolar visualisation and direct bacterial detection, the potential for bronchoscopy is increasing concomitantly. Despite this, there remain concerns regarding the safety of the technique and its benefits versus less invasive sampling techniques. These discussions are reflected in the lack of consensus among international guidelines on the topic. This review will consider the benefits and challenges of diagnostic bronchoscopy in the context of severe respiratory infection.<\/jats:p>","DOI":"10.3390\/jcm13196020","type":"journal-article","created":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T12:22:48Z","timestamp":1728476568000},"page":"6020","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Bronchoscopic Diagnosis of Severe Respiratory Infections"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4410-3672","authenticated-orcid":false,"given":"Maire","family":"R\u00f6der","sequence":"first","affiliation":[{"name":"School of Clinical Medicine, Addenbrooke\u2019s Hospital, University of Cambridge, Hills Road, Cambridge CB2 0QQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4870-1194","authenticated-orcid":false,"given":"Anthony Yong Kheng Cordero","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Medicine, Addenbrooke\u2019s Hospital, University of Cambridge, Hills Road, Cambridge CB2 0QQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3211-3216","authenticated-orcid":false,"given":"Andrew","family":"Conway Morris","sequence":"additional","affiliation":[{"name":"Department of Medicine, Addenbrooke\u2019s Hospital, University of Cambridge, Hills Road, Cambridge CB2 0QQ, UK"},{"name":"Division of Immunology, Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 0QQ, UK"},{"name":"JVF Intensive Care Unit, Addenbrooke\u2019s Hospital, Hills Road, Cambridge CB2 0QQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1007\/s00134-024-07381-z","article-title":"Challenges for a broad international implementation of the current severe community-acquired pneumonia guidelines","volume":"50","author":"Salluh","year":"2024","journal-title":"Intensive Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1136\/thoraxjnl-2016-209065","article-title":"16S pan-bacterial PCR can accurately identify patients with ventilator-associated pneumonia","volume":"72","author":"Gadsby","year":"2017","journal-title":"Thorax"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1378\/chest.122.1.262","article-title":"Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia","volume":"122","author":"Iregui","year":"2002","journal-title":"Chest"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/s00134-020-05929-3","article-title":"Antimicrobial-associated harm in critical care: A narrative review","volume":"46","author":"Arulkumaran","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1007\/s00134-023-07108-6","article-title":"Differentiating infection, colonisation, and sterile inflammation in critical illness: The emerging role of host-response profiling","volume":"49","author":"Jeffrey","year":"2023","journal-title":"Intensive Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Reyes, L.F., Mayorga, C., Zhang, Z., Tsuji, I., De Pascale, G., Prieto, V., Mer, M., Sheehan, E., Nasa, P., and Zangana, G.A.S. 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