Role of bronchoalveolar lavage in evaluating new pulmonary infiltrates on computed tomography in haematology patients with fever unresponsive to broad-spectrum antibiotics

Todd, Tony; Enoch, David

doi:10.1099/jmm.0.009910-0

Cited by 3 publications

(5 citation statements)

References 7 publications

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“…We found that the quantitative BAL fluid bacterial culture yield was as low as 2.94% in patients with pneumonia who were already on antimicrobials. This yield is much lower than that of previous studies, which reported 30-80% culture rates [14-17], possibly due to use of antimicrobials before BAL. Preculture antimicrobials significantly decrease the yield of blood and sputum cultures [18-21].…”

Section: Discussioncontrasting

confidence: 66%

Bacterial Yield from Quantitative Cultures of Bronchoalveolar Lavage Fluid in Patients with Pneumonia on Antimicrobial Therapy

Kim

Lee

et al. 2012

Korean J Intern Med

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Background/AimsEarly diagnosis and appropriate antimicrobial choice are crucial when managing pneumonia patients, and quantitative culture of bronchoalveolar lavage (BAL) fluid is considered a useful method for identifying pneumonia pathogens. We evaluated the quantitative yield of BAL fluid bacterial cultures in patients being treated with antimicrobials and attempted to identify factors predictive of positive BAL cultures.MethodsPatients over 18 years old and whose BAL fluid was subjected to quantitative culture to identify the organism causative of pneumonia between January 1, 2005, and December 31, 2009, were included. We reviewed the results of BAL fluid bacterial cultures and the clinical records, laboratory tests, and radiographic findings of the patients.ResultsBAL was performed on 340 patients with pneumonia. A positive BAL culture, defined as isolation of more than 104 colony forming units/mL bacteria, was documented in 18 (5.29%) patients. Of these, 9 bacteria isolated from 10 patients were classified as probable pathogens. The most frequently isolated bacteria were methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii, and Pseudomonas aeruginosa. No independent predictive factor for positive BAL cultures was identified.ConclusionsThe yield of quantitative BAL fluid bacterial culture in patients already on antimicrobials was low. Clinicians should be cautious when performing a BAL culture in patients with pneumonia who are already on antimicrobials.

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Section: Discussioncontrasting

confidence: 66%

Bacterial Yield from Quantitative Cultures of Bronchoalveolar Lavage Fluid in Patients with Pneumonia on Antimicrobial Therapy

Kim

Lee

et al. 2012

Korean J Intern Med

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“…Clearly, in severely thrombocytopenic or dyspnoeic patients, this indication may be reconsidered. Even though the use of BAL in neutropenic fever patients with chest infiltrates has been studied, it has not been reported whether the presence of this radiological sign was associated with a higher chance of isolating fungi from these BALs 26–34 …”

Section: Resultsmentioning

confidence: 99%

“…Background: Bronchoalveolar lavage is generally considered a safe procedure, even though complications like haemorrhage or aggravation of respiratory decompensation may occur in 1-2% of all patients. [26][27][28][29][30][31][32][33][34] According to the current guidelines, it should be performed in patients with neutropenic fever and lung infiltrates on their chest CT scan. 35 Clearly, in severely thrombocytopenic or dyspnoeic patients, this indication may be reconsidered.…”

Section: Questionsmentioning

confidence: 99%

“…Even though the use of BAL in neutropenic fever patients with chest infiltrates has been studied, it has not been reported whether the presence of this radiological sign was associated with a higher chance of isolating fungi from these BALs. [26][27][28][29][30][31][32][33][34] Online responses: Thirty participants (71.4%) would always perform a BAL if the patientÕs clinical situation allowed for it, five (11.9%) would perform a BAL if the patient had failed first-line antifungal treatment and four (9.5%) if the halo sign had appeared under prophylactic treatment with an Aspergillus spp. active azole.…”

Section: Questionsmentioning

confidence: 99%

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Current issues in the clinical management of invasive aspergillosis – the AGIHO, DMykG, ÖGMM and PEG web‐based survey and expert consensus conference 2009

Rüping¹,

Vehreschild²,

Groll³

et al. 2011

Mycoses

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The objectives of this study were to identify unsolved issues in the management of invasive aspergillosis, identify controversies and achieve consensus. The German Speaking Mycological Society (Deutschsprachige Mykologische Gesellschaft, DMykG) invited other German infectious diseases (ID) and mycological societies to submit unsolved issues concerning the diagnosis and treatment of invasive aspergillosis. Based on these contributions, a digital web-based questionnaire of 12 questions on Aspergillus spp. was designed to be completed by experts of the participating societies. Controversial results were identified by a mathematical model and were discussed at a consensus conference during the 43rd Annual Meeting of the DMykG in Cologne, Germany. Forty-two individuals completed the questionnaire. Analysis showed a strong consensus on effective preventive measures, choice of antifungal agents for pre-emptive, empiric and targeted treatment, as well as the evaluation of early chest CT control scans as a measure of treatment response assessment. Opinions on the indication for a pulmonary biopsy of a halo sign in high-risk neutropenic patients and on the role of Aspergillus spp. PCR as well as galactomannan from serum in the assessment of treatment duration diverged in spite of discussion such that a consensus could not be reached. Using a recently published two-step approach - web-based survey plus classical panel discussion - expert consensus was achieved on 10 of 12 questions concerning the diagnosis and treatment of invasive aspergillosis.

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“…Earlier studies have revealed the diagnostic yield of BAL between 33-80% [27][28][29][30]. Pseudomonas was the comment organism found in the culture, and this was due to the nature of patients who underwent…”

Section: Complications During and After The Bronchoscopy Proceduresmentioning

confidence: 99%

Indications, Efficacy, and Complications of Pediatric Bronchoscopy: A Retrospective Study at a Tertiary Center

Yavuz,

Sherif,

Saif

et al. 2023

Cureus

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BackgroundBronchoscopy is an essential procedure for evaluating, diagnosing, and treating pediatric respiratory diseases. In this study, we demonstrate the indications and contraindications of bronchoscopy done in a tertiary referral hospital, Al Qassimi Woman's and Children's Hospital (AQWCH) in Sharjah, United Arab Emirates (UAE), in order to achieve better service. This study aims to evaluate patients' characteristics, diagnostic and therapeutic indications, and complications of bronchoscopy. Material and methodThis retrospective chart review included children aged between one day and 13 years, admitted to AQWCH, who underwent bronchoscopy (rigid or flexible) procedures between January 2018 and December 2019. All patients were identified by using a computerized search of hospital discharge diagnosis, which was codified as "pediatric bronchoscopy, flexible, rigid, bronchoalveolar lavage". The main study outcome measure was to evaluate patients' characteristics, diagnostic or therapeutic indications, bronchoalveolar lavage (BAL) analysis, as well as complications of bronchoscopy at AQWCH. ResultsThere were 72 pediatric bronchoscopies (rigid and flexible) performed in patients aged less than 13 years old; the reason for bronchoscopy procedure was diagnostic in 51% and both diagnostic and therapeutic in 49%. Cough was the most common symptom (n=53; 74%), and chest recession was the most common clinical finding (n=46; 64%). Foreign body aspiration was the main indication (n=23; 32%), followed by stridor (26%). Consolidation was the most common radiological finding. Foreign body was the common finding, seen in 25% of bronchoscopies, followed by tracheomalacia in 17%. The suspected diagnosis was confirmed in 89%, and management change was needed in 54% of patients. The main complication during the procedure was desaturation (26%), and cough was the main post-bronchoscopy complication (14%). BAL was done for 28 (39%) patients, in which BAL culture was positive in 75%. Rigid bronchoscopy was done when foreign body aspiration was suspected based on positive history in 70%, abnormal physical examination in 60%, and chest X-ray abnormalities in 39% of patients. Sensitivity and specificity for patient history, physical examination, and chest X-ray were 80% and 83%, 66% and 60%, and 40% and 66 %, respectively. ConclusionBronchoscopy is an important tool for evaluating, diagnosing, and treating pediatric respiratory diseases. While it is a safe procedure, it still needs a careful selection of patients as it is invasive.

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Role of bronchoalveolar lavage in evaluating new pulmonary infiltrates on computed tomography in haematology patients with fever unresponsive to broad-spectrum antibiotics

Abstract: JMM CorrespondenceRole of bronchoalveolar lavage in evaluating new pulmonary infiltrates on computed tomography in haematology patients with fever unresponsive to broad-spectrum antibiotics

Cited by 3 publications

References 7 publications

Bacterial Yield from Quantitative Cultures of Bronchoalveolar Lavage Fluid in Patients with Pneumonia on Antimicrobial Therapy

Bacterial Yield from Quantitative Cultures of Bronchoalveolar Lavage Fluid in Patients with Pneumonia on Antimicrobial Therapy

Current issues in the clinical management of invasive aspergillosis – the AGIHO, DMykG, ÖGMM and PEG web‐based survey and expert consensus conference 2009

Indications, Efficacy, and Complications of Pediatric Bronchoscopy: A Retrospective Study at a Tertiary Center

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