Bronchoscopic evaluation of pulmonary infiltrates following bone marrow transplantation

Chest
D P DunaganE F Haponik

Abstract

To determine the impact of fiberoptic bronchoscopy (FOB), including quantitative bacterial cultures obtained by BAL and protected specimen brushing on therapeutic decisions and outcome in bone marrow transplant (BMT) patients. Retrospective review of all BMT patients undergoing FOB during a 4-year period. A tertiary care university hospital. Three hundred five patients underwent BMT; 71 (23%) had FOB to assess pulmonary infiltrates. Allogeneic BMT recipients underwent FOB 3.37 times more often than autologous recipients (p < 0.001). Pathogens were identified in 31 (46%) patients undergoing FOB; bacteria were most commonly isolated although 86% of patients had received broad-spectrum empiric antibiotics. Therapy was changed in 20 (65%) patients when a microorganism was identified and in 9 (22%) with nondiagnostic results (p = 0.0026), but isolation of a presumed pathogen had no apparent effect on survival. There were 19 (27%) FOB complications, including bleeding in 8 (11%) patients and death in 2 (3%). Major complications were associated with prolonged prothrombin time (p = 0.006) and were more common (36% vs 14%; p < 0.05) in patients who had protected specimen brushing vs BAL alone. Mortality at 40 months in BMT patients not ...Continue Reading

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Citations

May 23, 2006·Intensive Care Medicine·Elie Azoulay, Benoît Schlemmer
May 6, 2009·Annals of Hematology·Dagmar KuehnhardtJan Eucker
Jun 30, 2004·The Annals of Thoracic Surgery·Jann-Yuan WangYung-Chie Lee
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