Therapeutic implication of BAL in patients with neutropenia

Abstract

Bronchoalveolar lavage (BAL) is a practicable procedure establishing the etiology of pneumonia. In patients with neutropenia, empirical antimicrobial treatment is mandatory immediately after diagnosis of infection, usually before results of BAL are available. We evaluated the impact of BAL on treatment and outcome of pneumonia in immunocompromised patients with a special regard to neutropenia. Bronchoscopy with BAL was performed in 58 episodes of clinical documented pneumonia in patients with hematological malignancies (88%) or solid tumors (12%), in 30 cases patients had neutropenia, in 28 cases patients had no neutropenia. In 93% of cases, BAL was performed under empirical antimicrobial treatment. BAL fluid was cultivated for bacteria, fungi, and tested for Pneumocystis jirovecii and cytomegalovirus (CMV). BAL revealed positive bacterial results in 67% of cases. Gram-positive microorganisms were detected in 95% of positive BAL results, gram-negative microorganisms in 23%, mixed bacterial cultures occurred in 41%. Positive fungi cultures were found in 59%. P. jirovecii was detected in 5% of cases tested and CMV in 8%. There was no significant difference between neutropenic and non-neutropenic patients. BAL results directed a change of therapy in only six of 58 episodes (5%). Overall mortality related to pneumonia was 16%. In this patient setting, the yield of BAL rarely has a significant influence on treatment and outcome of pneumonia. The early beginning of antimicrobial treatment reduces the diagnostic yield of BAL. In patients with pneumonia during neutropenia, its use should be well considered.

Performance of a standardized bronchoalveolar lavage protocol in a comprehensive cancer center

“…In contrast to previously reported associations between pathogen identification and improved outcomes, 2,9,10 the 30-day mortality rate among patients with hematologic malignancies was greater for patients who had a diagnostic BAL compared with patients who had a nondiagnostic BAL (31% vs 13.6%; P = .006). In the nonhematologic malignancy group, the 30-day mortality rate did not differ significantly according to diagnostic versus nondiagnostic status.…”

Safety and Benefits of Bronchoalveolar Lavage and Lung Biopsy in the Management of Pulmonary Infiltrates in Children With Leukemia

“…In a cohort of 26 adults with hematological disorders and febrile neutropenia, the diagnostic yield for BAL was 23% [8]. In another adult immunocompromised cohort, there was a trend towards higher yield in non-neutropenic patients versus those who were neutropenic (79% versus 57%) [9]. In our cohort, BAL yield was 81% in non-neutropenic children compared to 61% in children with neutropenia although the difference wasn’t statistically significant.…”

“…In fact, immunocompromised patients with neutropenia tend to have lower yield with BAL compared to non-neutropenic patients [8, 9]. In a cohort of 26 adults with hematological disorders and febrile neutropenia, the diagnostic yield for BAL was 23% [8].…”

Cáncer, neutropenia febril e imágenes pulmonares: Hallazgos en el lavado broncoalveolar en niños

“…La obtención de resultados negativos también puede ser de utilidad permitiendo suspender tratamientos empíricos injustificados, ya que valida la ausencia de patógenos bacterianos, virales o micóticos 7 . El uso temprano y sistemático del LBA por FBC con técnicas microbiológicas cuantitativas y de biología molecular, mejora los resultados etiológicos permitiendo tratamientos más oportunos y específicos 20,21 . En nuestra serie a pesar del retraso en su realización, en 32,4% de los pacientes se identificó etiología infecciosa por LBA.…”