A bronchoalveolar lavage‐driven antimicrobial treatment improves survival in hematologic malignancy patients with detected lung infiltrates: A prospective multicenter study of the SEIFEM group

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BackgroundAlthough bronchoalveolar lavage (BAL) measurements of galactomannan antigen (GM) seems to be more sensitive than serum testing to detect invasive fungal infection (IFI), a consensus on the most appropriate diagnostic threshold of the BAL GM test is still unclear. Moreover, there is uncertainty as to whether BAL is a safe procedure in patients with hematological malignancies (HM) and thrombocytopenia.ObjectivesBased on this background, 102 adult patients with HM and associated thrombocytopenia were retrospectively analyzed with the dual aim of 1) determining whether BAL is a safe and feasible procedure; and, 2) identifying the most appropriate threshold for GM positivity in the diagnosis of IFI.Patients/Methodseach BAL was considered as one case/patient. One hundred twelve BALs were carried out in 102 HM patients: at the time of the BAL, the median platelet count (PLTs) in all patients was 47×109/L (1–476), and 31 patients (27%) had PLTs< 20×109/L.Resultscomplications from the BAL were infrequent (3.5%) and mild. No bleeding was reported. The BAL GM cut off of >0.8 was associated with the best diagnostic accuracy (sensitivity 72.97% and specificity 80%). Antifungal treatment of patients with BAL GM >0.8 resulted in a clinical-radiological improvement in 35/41 patients (85%).ConclusionsBAL was a safe procedure also in thrombocytopenic patients, permitting an IFI diagnosis not otherwise identifiable using EORTC/MSG criteria. Our data suggest that a BAL GM value of>0.8 represents the most useful cut-off in terms of sensibility and specificity. Further prospective studies on a more significant number of patients are needed to confirm these results.

Section: Discussionsupporting

confidence: 77%

Diagnostic Performance and Safety of Bronchoalveolar Lavage in Thrombocytopenic Haematological Patients for Aspergillosis Diagnosis: A Monocentric, Retrospective Experience.

Cefalo

Puxeddu

Sarmati

et al. 2019

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“…As far as outcome is concerned, 16 (34%) patients had oxygen saturation lower than 90%, and 25 (53.2%) had a platelet count <50,000/mm 3 (3 of which had <10,000/mm 3 ) at the time of bronchoscopy. Breath rate and oxygen saturation were 20 (12-26) vs 20 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26), (p = 0.41) and 95 (64-100) vs 95 (86-98), (p = 0.74) before and after bronchoscopy, respectively.…”

Section: Methodsmentioning

confidence: 94%

“…[11][12][13][14][15] However, there is scarce robust evidence for its usefulness as a tool for therapeutic decision-making (even with positive microbiological culture results) and its impact on patients' outcome and continues to be investigated. 6,12,16,17,18 The main purpose of the present study was to describe the etiology of PI in patients with hematological malignancies under chemotherapy or stem cell transplantation. Secondary objectives were to assess BAL diagnostic yield and usefulness as a therapeutic decision approach, and finally to describe BAL safety in this subset of patients.…”

mentioning

confidence: 99%

Clinical Usefulness of Brochoalveolar Lavage in the Management of Pulmonary Infiltrates in Adults With Haematological Malignancies and Stem Cell Transplantation

Jorge

Torres

Languasco

et al. 2020

Introduction: Pulmonary complications are frequent in patients with hematologic malignancies and stem cell transplantation. Regardless of the microbiological usefulness of bronchoalveolar lavage (BAL), little information exists on both its benefits as a guide for therapeutic decisions and its impact on patients’ clinical outcome. Methods: A prospective observational single center study was performed between July 2011 and July 2015. Consecutive episodes of pulmonary infiltrates were analyzed in subjects over 18 years of age who presented hematologic malignancies and underwent chemotherapy or stem cell transplantation. Results: Ninety-six episodes of pulmonary infiltrates were analyzed. Acute leukemia was the most frequent underlying condition. Thirty-seven patients (38.5%) received a stem cell transplant. Sixty-one (62.9%) were neutropenic at the moment of inclusion in the study. A definitive etiologic diagnosis was obtained in 41 cases (42.7%), where infection accounted for the vast majority of causes (33 cases, 80.5%). Definitive diagnosis was reached by non-invasive methods in 13 cases (13.5%). BAL was performed in 47 cases, and led to a diagnosis in 40.4% of the cases. BAL results led to therapeutic changes in 27 cases (57.4%), including the addition of new antimicrobials to empiric treatments in 10. Regarding BAL’s safety, 2 patients experienced minor adverse events and 1 a severe adverse event; no procedure-related deaths were observed. Conclusions: Infection was the leading cause of pulmonary infiltrates in patients with hematologic malignancies and stem cell transplantation. BAL was a useful decision-making diagnostic tool, with minor adverse events

“…In particular, pneumonia etiology was documented by performing a bronchoalveolar lavage fluid analysis, as previously described. 6 The study was approved in the context of an institutional antimicrobial stewardship program (PT-DSA-01–2019-rev.0) and was conducted in accordance with the Helsinki declaration. All enrolled patients signed informed consent for data analysis for scientific purposes.…”

Section: To the Editormentioning

confidence: 99%

Ceftolozane-Tazobatam for febrile neutropenia treatment in hematologic malignancy patients colonized by multi-resistant Enterobacteriaceae: preliminary results from a prospective cohort study

Marchesi

Toma

Domenico

et al. 2020

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