Study objectives: To assess the incidence of fever and
bacteremia after fiberoptic bronchoscopy in immunocompetent
Design: Prospective study.
Patients: Immunocompetent children undergoing fiberoptic
bronchoscopy between January 1997 and June 1998.
Measurements and results: Ninety-one children were included
in the study. Forty-four children (48%) developed fever within 24
h following bronchoscopy. Bacteremia was not detected in any of the
cases at the time of the fever. Children who developed fever were
younger than those who remained afebrile (mean age, 2.4 ± 3.6 years
vs 4.2 ± 3.7 years; p = 0.025). In the fever group, 66% of the
bronchoscopies were considered abnormal, compared to 45% in the
nonfever group (p = 0.04). Of the fever group, 40.5% of BAL fluid
cultures had significant bacterial growth, significantly higher
compared to the nonfever group (13.2%; p = 0.006). Of the 80
patients in whom BAL was performed, fever occurred in 52.5% compared
to only 18.2% in those who did not have BAL (p = 0.03). BAL fluid
content of cell count, lipid-laden macrophages, and interleukin-8 were
not significantly different in both groups. In a logistic regression
analysis, the significant predictors for developing fever were positive
bacterial culture (relative risk, 5.1; 95% confidence interval, 1.6 to
16.4; p = 0.007) and abnormal bronchoscopic findings (relative risk,
3.1, 95% confidence interval, 1.2 to 8.3; p = 0.02). When age < 2
years was included in the model, this factor became highly significant
(relative risk, 5.01; 95% confidence interval, 1.83 to 13.75;
p < 0.002).
Conclusions: Fever following
fiberoptic bronchoscopy is a common event in immunocompetent children
and is not associated with bacteremia. Risks to develop this
complication are age < 2 years, positive bacterial cultures in BAL
fluid, and abnormal bronchoscopic findings.