The role of fibreoptic bronchoscopy (FOB) in the management of pulmonary disease in the immunocompromised (IC) host

Ref ID: 18415

Author:

Shironjit Saha, Joanne Creaser, Charlie Elliot, Stephen Bianchi1.

Author address:

Sheffield
Thoracic Institute, Sheffield Teaching Hospital NHS Trust, Sheffield, United
Kingdom; Clinical Effectiveness Unit, Sheffield Teaching Hospital NHS Trust,
Sheffield, United Kingdom

Full conference title:

European Respiratory Congress

Abstract:

Introduction: FOB is a recognised tool in evaluating IC patients with lung disease.
It is often utilised after administration of antimicrobial therapy which potentially
affects diagnostic rate.
Aims: Assessment of the role of FOB in IC patients presenting to a UK hospital
between December 2007-09.
Method: Retrospective data was reviewed for 48 patients.
Results: 19/48 (39.6%) presented with leucopenia (WCC <3.5x 109/l), 18/48 (37.5%) with neutropenia (PMN<1.7x 109/l) and 30/48 (62.5%) had lymphopenia (Lí˜<1.0x 109/l). Significant desaturation (requiring unplanned intervention) occurred in 7/48 (14.6%) patients. 30 day mortality was 11%. Positive bacterial cultures were obtained in 10/48 samples (21%). Organisms: Proteus, H.Influenza, Ps.Aeruginosa, Klebsiella, S.Aureus, S.Maltophilia, Coagulase negative staphylococci, enterococcus, E.coli and Group B streptococcus. 17/48 (35%) patients had a change in management directly resultant from BAL bacterial culture. Positive fungal cultures were identified in 16/48 (33.3%) samples. Species: C.Albicans, Saccaromyces, Aspergillus and C.Glabrata. 8/48 (17%) patients had treatment altered based on BAL fungal culture. Positive virology identified in 10/48 patients (rhinovirus, CMV,HSV type 1, EBV, coronavirus). 4/48 (8%) patients had resultant changes in treatment. 7/45 (16%) patients were positive for Pneumocystis jirovecii with treatment change in 5 patients. In 40.5% of cases a treatment change was based on FOB/BAL results. Conclusion: FOB/BAL has a major impact on the treatment of IC patients with pulmonary disease. Early respiratory involvement prior to broad spectrum antimicrobial therapy may have increased FOB yield.

Abstract Number: P2521

Conference Year: 2011

Link to conference website: http://www.ers-education.org/ersMade/abstract_print_11/files/Abstract_book_2011.pdf

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