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Bronchoscopy with bronchoalveolar lavage: determinants of yield and impact on management in immunosuppressed patients

2010; BMJ; Volume: 66; Issue: 9 Linguagem: Inglês

10.1136/thx.2010.145540

1468-3296

R. Matthew Kottmann, Jennifer L. Kelly, Elizabeth Lyda, Michael Gurell, Jennifer J. Stalica, Wayne D. Ormsby, Ki Hak Moon, David Trawick, PJ Sime,

Pneumonia and Respiratory Infections

Fibreoptic bronchoscopy with bronchoalveolar lavage (FOB/BAL) is a common modality for the evaluation of pulmonary infiltrates.1 2 We recognised there are limitations of comparison between subgroups of immunosuppressed patients, non-uniform definitions of a positive yield, suboptimal description of the impact of concurrent antimicrobial use at the time of the bronchoscopy and sometimes insufficient assessment of management decisions surrounding FOB/BAL.3–5 To address these issues, we performed a retrospective analysis of 190 immunosuppressed patients who underwent FOB/BAL for a pulmonary abnormality (clinical or radiographic) at the University of Rochester Medical Center from 2005 to 2008. A positive yield was defined as one of the following: (1) positive culture—bacterial, viral or fungal (not including Candida albicans alone); (2) positive finding on cytopathology or fungal stain; or (3) diffuse alveolar haemorrhage. Antimicrobial and corticosteroid treatment changes …