PURPOSE: Bronchoalveolar lavage (BAL) is effective in diagnosing infectious causes of pulmonary infiltrates particularly in immunocompromised patients. Leukemic and bone marrow transplant (BMT) patients are at increased risk for pneumonia and are usually on multiple antimicrobials at the time of bronchoscopy. We queried the yield of bronchoscopy in this population hypothesizing that antimicrobial treatment decreases the diagnostic yield of BAL.
METHODS: Retrospective chart review of three hundred non-HIV leukemic and BMT patients who underwent inpatient bronchoscopy at a single academic cancer center.
RESULTS: Among the 299 patients studied, 293 (98%) were on antimicrobials. The total positive yield of BAL was 50.8%. Patients on antimicrobials from 0 - 24 hours at the time of bronchoscopy were more likely to have a positive BAL result compared to those on antimicrobials >24 hours (66.7% vs. 48.6%; p-value 0.043). A recent antibiotic change was associated with a positive BAL (54.7% vs. 39.3%,, p-value 0.029). Neutropenic patients had fewer positive BALs compared with non-neutropenic patients (43.1% versus 63.6%, p-value 0.0.023). A positive BAL result was obtained in 70.8% of mechanically ventilated patients versus 48.1% of spontaneously breathing patients (p-value 0.033).
CONCLUSIONS: Leukemic and BMT patients with pulmonary infiltrates were usually on antimicrobials at the time of BAL. A shorter duration of antimicrobials correlated with a positive BAL yield. For patients on antibiotics >48 hours, a recent antibiotic change was associated with a better yield, which may be a reflection of new infection or severity of illness. Neutropenic patients were less likely to have a positive BAL result. Mechanically ventilated patients had a higher BAL yield, which may be a reflection of sample size or disease burden.
CLINICAL IMPLICATIONS: Bronchoscopy with BAL is a useful tool in the assessment of leukemic and bone marrow transplant patients with pulmonary infiltrates. Antimicrobial therapy should not be a limiting factor in obtaining a BAL specimen. The overall BAL yield is better with shorter duration of antimicrobial therapy, recent change in antimicrobials, lack of neutropenia, and mechanical ventilatory support.
DISCLOSURE: The following authors have nothing to disclose: Dani Thomas, Arthur Andrews, John Greene, Frank Walsh, David Solomon, Katheryne Downes, Carol Yuan, Todd Hazelton
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