Study objective: To determine the impact of fiberoptic bronchoscopy (F
OE), including quantitative bacterial cultures obtained by BAL and pro
tected specimen brushing on therapeutic decisions and outcome in bone
marrow transplant (BMT) patients. Design: Retrospective review of all
BMT patients undergoing FOE during a 4-year period. Setting: A tertiar
y care university hospital. Results: Three hundred five patients under
went BMT; 71 (23%) had FOE to assess pulmonary infiltrates. Allogeneic
BMT recipients underwent FOE 3.37 times more often than autologous re
cipients (p<0.001). Pathogens were identified in 31 (46%) patients und
ergoing FOE; bacteria were most commonly isolated although 86% of pati
ents had received broad-spectrum empiric antibiotics. Therapy was chan
ged in 20 (65%) patients when a microorganism was identified and in 9
(22%) with nondiagnostic results (p=0.0026), but isolation of a presum
ed pathogen had no apparent effect on survival. There were 19 (27%) FO
E complications, including bleeding in 8 (11%) patients and death in 2
(3%). Major complications were associated with prolonged prothrombin
time (p=0.006) and were more common (36% vs 14%; p<0.05) in patients w
ho had protected specimen brushing vs BAL alone. Mortality at 40 month
s in BMT patients not requiring FOE was 33% compared with 61% mortalit
y in those undergoing FOE (p<0.001); mortality was 96% in patients wit
h respiratory failure requiring mechanical ventilation. Conclusion: FO
E is diagnostically useful in the evaluation of some BMT patients with
pulmonary complications and often influences therapy, although no imp
act on survival was clearly demonstrated. FOE should be performed only
after benefits of the procedure are weighed carefully against its inc
reased risk in this select population.