Introduction: Prolonged periods of neutropenia complicate the oncologic care of patients, especially those being treated for leukemia and lymphoma. Neutropenic patients frequently develop fevers and/or infiltrates on radiograph. The pulmonologist is frequently consulted upon these patients to aid in the diagnosis of possible infection utilizing bronchoalveolar lavage (BAL) via bronchoscopy. Neutropenic patients often have already begun broad-spectrum empiric antimicrobials prior the performance of the BAL, possibly decreasing the diagnostic yield. We examined the diagnostic utility of the BAL in neutropenic fevers on patients already receiving antimicrobials prior to the BAL. Methods: A retrospective review of the bronchoscopy database at the University of Chicago analyzing all patients undergoing bronchoscopy by a single operator for the indication of neutropenic fevers with infiltrates already receiving empiric antimicrobials. Results: 50 bronchoscopies with BAL for neutropenic fevers were available for review. All BALs were sent for quantitative culture, acid-fast (AFB) culture, fungal culture, viral culture, PCJ assay, and cell count with differential. All patients were receiving empiric antimicrobials at the time of BAL. Amongst the patients undergoing BAL, 40% were being treated for leukemia, 20% were being treated for lymphoma, and 40% were neutropenic for other cancers (myeloma, breast, lung). Average BAL volume in the affected segment was 133ml (range 10ml to 360ml) with average return of 43ml (range 0ml to 180ml). BAL results were as follows: 7 out of 50 (14%) positive for microbial culture (Pseudomonas, MRSA, MSSA, Klebsiella, Legionella, Enterobacter). 3 out of 50 (6%) positive for AFB culture (M. avium and M. fortuitum). 3 out of 50 (6%) positive for fungal cultures (Aspergillus, Paecilomyces). 8 out of 50 (16%) positive for viral cultures (CMV, Parainfluenza, Influenza, RSV). 1 out of 50 (2%) positive for Pneumocystis. Hemosiderin-Laden Macrophages were demonstrated in 6 out of 50 (12%). No patients required reversal of sedation, intubation, ICU transfer, or worsening oxygen requirement after the procedure. Discussion: As demonstrated by our data, diagnostic BAL is an important tool to aid in the diagnosis and management of neutropenic fevers. The procedure can be performed safely and provides an acceptable diagnostic yield, even in the setting of empiric antimicrobials.
Poster Board # 903
Full conference title:
American Thoracic Society International Conference
- ATS 2010