The clinical importance of bronchoalveolar lavage in allogeneic SCT patients with pneumonia

Forslöw, Ulrica; Remberger, Mats; Nordlander, Anna; Mattsson, Jonas

doi:10.1038/bmt.2009.268

Cited by 31 publications

(40 citation statements)

References 32 publications

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“…Furthermore, radiographic findings of pulmonary infiltrates in HSCT recipients may indicate noninfectious processes, including GVHD, disease recurrence, and treatment/ transplantation-associated toxicity [12]. …”

Section: Introductionmentioning

confidence: 99%

A Comparison of Bronchoalveolar Lavage versus Lung Biopsy in Pediatric Recipients after Stem Cell Transplantation

Qualter

Satwani

Ricci

et al. 2014

Biology of Blood and Marrow Transplantation

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Bronchoalveolar lavage (BAL) has been a useful initial diagnostic tool in the evaluation of pulmonary complications after hematopoietic stem cell transplantation (HSCT); however, the diagnostic sensitivity, prevalence, and outcome after BAL versus lung biopsy (LB) in pediatric HSCT patients remains to be determined. We reviewed 193 pediatric HSCT recipients who underwent a total of 235 HSCTs. Sixty-five patients (34%) underwent a total of 101 BALs for fever, respiratory distress, and/or pulmonary infiltrates on chest radiograph and/or computed tomography scan. The 1-year probability of undergoing BAL was 43.0% after allogeneic stem cell transplantation (alloSCT) and 8.5% after autologous stem cell transplantation (autoSCT) (P =.001). Sixteen of the 193 patients (8%) patients underwent 19 LBs. The probability of undergoing LB at 1 year after HSCT was 9.3%. No grade III or IV adverse events related to either procedure were observed. Of the 101 BALs performed, 40% (n = 40) were diagnostic, with a majority revealing a bacterial pathogen. Among the 19 LBs performed, 94% identified an etiology. In multivariate analysis, myeloablative conditioning alloSCT conferred the highest risk of requiring a BAL (hazard ratio [HR],8.5; P = .0002). The probability of 2-year overall survival was 20.2% in patients who underwent BAL, 17.5% for patients who underwent biopsy, and 67.4% for patients who had neither procedure. In multivariate analysis, only the requirement of a BAL was independently associated with an increased risk of mortality (HR, 2.96; P < .0001). In summary, in this cohort of pediatric HSCT recipients, BAL and LB were used in approximately 35% and 8% of pediatric HSCTs with diagnostic yields of approximately 40% and 94%, respectively, and were both associated with poor long-term outcomes.

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Section: Introductionmentioning

confidence: 99%

A Comparison of Bronchoalveolar Lavage versus Lung Biopsy in Pediatric Recipients after Stem Cell Transplantation

Qualter

Satwani

Ricci

et al. 2014

Biology of Blood and Marrow Transplantation

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“…A similar study of 93 neutropenic patients revealed respiratory microorganisms in 49% of BAL samples [6]. Yet another study demonstrated a microorganism isolation rate of 63% for BAL in a series of 57 allogeneic bone marrow transplant recipients with pneumonia [20]. Such studies support the utility of BAL in helping to characterize pneumonia pathogens in immunosuppressed patients.…”

Section: Discussionmentioning

confidence: 62%

Comparison of Bronchoalveolar Lavage and Mini-Bronchoalveolar Lavage in the Diagnosis of Pneumonia in Immunocompromised Patients

et al. 2011

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Background: Pneumonia is a major cause of morbidity and mortality in immunocompromised patients. Bronchoalveolar lavage (BAL) is commonly used to help diagnose and characterize pneumonia in these patients. Mini-BAL is a less-invasive, less-costly and less-cumbersome diagnostic tool than BAL. Objectives: In this study, we compared the diagnostic value of BAL and mini-BAL in the evaluation of pneumonia in immunocompromised patients with respiratory failure. Methods: Sixty-four respiratory samples were collected from 32 immunocompromised patients admitted to our respiratory intensive care unit with a clinical diagnosis of pneumonia and respiratory failure requiring invasive mechanical ventilation. A single BAL sample and a single mini-BAL sample were collected from each patient. Samples were examined for bacteriologic, mycologic, mycobacteriologic, and viral organisms. Results: The mean age of the patients was 56.0 ± 14.4 years. Of the 32 BAL samples, bacterial isolates were detected in 11 patients (34.4%) and on the other hand bacterial isolates were detected in 10 patients (31.3%) of the mini-BAL samples. Fungal isolates were detected in 11 patients (34.4%) from BAL samples and 13 patients (40.6%) from mini-BAL samples. Our analysis demonstrated a strong positive correlation between the results of BAL and mini-BAL testing (r = 0.850 and r = 0.821, respectively). Conclusion: In this study, we demonstrated a strong correlation between the isolation rates of bacteria and fungi in BAL and mini-BAL samples obtained from immunocompromised patients with pneumonia and respiratory failure. The data strongly support the use of mini-BAL sampling in such patients as a less-invasive, less-costly and simpler alternative to traditional BAL.

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“…Fiber-optic bronchoscopy and bronchoalveolar lavage (BAL) have generally been considered as safe and accurate procedures for evaluation of patients having pulmonary infiltrates (94–96). The diagnostic yield of bronchoscopy in HSCT recipients may reach 75% and the results of BAL may change treatment in up to 51% of episodes of pneumonia (94–96).…”

Section: New Diagnostic Methodsmentioning

confidence: 99%

“…The diagnostic yield of bronchoscopy in HSCT recipients may reach 75% and the results of BAL may change treatment in up to 51% of episodes of pneumonia (94–96). …”

Section: New Diagnostic Methodsmentioning

confidence: 99%

“…Lung biopsies carry significant risk of morbidity and mortality in recipients of HSCT who are fragile, thrombocytopenic, and immunocompromised (94). Patients with HM and recipients of HSCT having pulmonary infiltrates or nodular lung lesions are at risk of treatment failure once conventional broad-spectrum antimicrobial therapies are used on empirical basis as filamentous fungi and MDR-GNB such as Pseudomonas aeruginosa and S. maltophilia may be involved etiologically (97).…”

Section: New Diagnostic Methodsmentioning

confidence: 99%

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Infections Caused by Stenotrophomonas maltophilia in Recipients of Hematopoietic Stem Cell Transplantation

Al-Anazi¹,

Al-Jasser²

2014

Front. Oncol.

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Stenotrophomonas maltophilia (S. maltophilia) is a globally emerging Gram-negative bacillus that is widely spread in environment and hospital equipment. Recently, the incidence of infections caused by this organism has increased, particularly in patients with hematological malignancy and in recipients of hematopoietic stem cell transplantation (HSCT) having neutropenia, mucositis, diarrhea, central venous catheters or graft versus host disease and receiving intensive cytotoxic chemotherapy, immunosuppressive therapy, or broad-spectrum antibiotics. The spectrum of infections in HSCT recipients includes pneumonia, urinary tract and surgical site infection, peritonitis, bacteremia, septic shock, and infection of indwelling medical devices. The organism exhibits intrinsic resistance to many classes of antibiotics including carbapenems, aminoglycosides, most of the third-generation cephalosporins, and other β-lactams. Despite the increasingly reported drug resistance, trimethoprim-sulfamethoxazole is still the drug of choice. However, the organism is still susceptible to ticarcillin-clavulanic acid, tigecycline, fluoroquinolones, polymyxin-B, and rifampicin. Genetic factors play a significant role not only in evolution of drug resistance but also in virulence of the organism. The outcome of patients having S. maltophilia infections can be improved by: using various combinations of novel therapeutic agents and aerosolized aminoglycosides or colistin, prompt administration of in vitro active antibiotics, removal of possible sources of infection such as infected indwelling intravascular catheters, and application of strict infection control measures.

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The clinical importance of bronchoalveolar lavage in allogeneic SCT patients with pneumonia

Cited by 31 publications

References 32 publications

A Comparison of Bronchoalveolar Lavage versus Lung Biopsy in Pediatric Recipients after Stem Cell Transplantation

A Comparison of Bronchoalveolar Lavage versus Lung Biopsy in Pediatric Recipients after Stem Cell Transplantation

Comparison of Bronchoalveolar Lavage and Mini-Bronchoalveolar Lavage in the Diagnosis of Pneumonia in Immunocompromised Patients

Infections Caused by Stenotrophomonas maltophilia in Recipients of Hematopoietic Stem Cell Transplantation

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