BRONCHOSCOPIC EVALUATION OF PULMONARY-INFILTRATES FOLLOWING BONE-MARROW TRANSPLANTATION

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.