A prospective study of fever and bacteremia after flexible fiberoptic bronchoscopy in children

Study objectives: To assess the incidence of fever and bacteremia after fib eroptic bronchoscopy in immunocompetent children. Design: Prospective study. Patients: Immunocompetent children undergoing fiberoptic bronchoscopy betwe en January 1997 and June 1998. Measurements and results: Ninety-one children were included in the study. F orty-four children (48%) developed fever within 24 h following bronchoscopy . Bacteremia was not detected in any of the cases at the time of the fever. Children who developed fever were younger than those who remained afebrile (mean age, 2.4 +/- 3.6 years vs 4.2 +/- 3.7 years; p = 0.025, In the fever group, 66% of the bronchoscopies were considered abnormal, compared to 45% in the nonfever group (p = 0.04). Of the fever group, 40.5% of BAL fluid c ultures had significant bacterial growth, significantly higher compared to the nonfever group (13.2%; p = 0.006). Of the 80 patients in whom BAL was p erformed, fever occurred in 52.9% compar ed to only 18.2% in those who did not have BAL (p = 0.03). BAL fluid content of cell count, Lipid-laden macro phages, and interleukin-8 were not significantly different in both groups. In a logistic regression anal lsis, the significant predictors for developi ng fever were positive bacterial culture (relative risk, 5.1; 95% confidenc e interval, 1.6 to 16.4; p = 0.007) and abnormal bronchoscopic findings (re lative risk, 3.1, 95% confidence interval, 1.2 to 8.3; p = 0.02). When age < 2 ears was included in the model, this factor became highly significant ( relative risk, 5.01; 95% confidence interval, 1.83 to 13.75; p < 0.002). Conclusions: Fever following fiberoptic bronchoscopy is a common event in i mmunocompetent children and is not associated with bacteremia, Risks to dev elop this complication are age < 2)ears, positive bacterial cultures in BAL fluid, and abnormal bronchoscopic findings.