Authors: Dagmar Kuehnhardt Manja Hannemann Bernd Schmidt Ulrike Heider Kurt Possinger Jan Eucker
Publish Date: 2009/05/05
Volume: 88, Issue: 12, Pages: 1249-1256
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 Grampositive microorganisms were detected in 95 of positive BAL results gramnegative 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 nonneutropenic 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
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