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Therapeutic implication of BAL in patients with neutropenia
- Source :
- Annals of Hematology, Annals of Hematology, Springer Verlag, 2009, 88 (12), pp.1249-1256. ⟨10.1007/s00277-009-0747-1⟩
- Publication Year :
- 2009
- Publisher :
- Springer Science and Business Media LLC, 2009.
-
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.
- Subjects :
- Adult
Male
medicine.medical_specialty
Neutropenia
Microbiological culture
Adolescent
Bronchoalveolar Lavage
Gastroenterology
Immunocompromised Host
Young Adult
03 medical and health sciences
0302 clinical medicine
Neoplasms
Internal medicine
medicine
Humans
Pneumocystis jirovecii
Aged
Retrospective Studies
BAL
medicine.diagnostic_test
biology
business.industry
Bacterial pneumonia
Pneumonia
Hematology
General Medicine
Middle Aged
respiratory system
medicine.disease
Antimicrobial
biology.organism_classification
Anti-Bacterial Agents
respiratory tract diseases
3. Good health
Treatment Outcome
Bronchoalveolar lavage
030228 respiratory system
030220 oncology & carcinogenesis
Immunology
Etiology
Female
business
Subjects
Details
- ISSN :
- 14320584 and 09395555
- Volume :
- 88
- Database :
- OpenAIRE
- Journal :
- Annals of Hematology
- Accession number :
- edsair.doi.dedup.....2f976326c0981e53bdb689318d41cca3