Diagnostic yield of bronchoscopic sampling in febrile neutropenic patients with pulmonary infiltrate and haematological disorders

Intern Med J. 2012 May;42(5):536-41. doi: 10.1111/j.1445-5994.2011.02643.x.


Background: The development of pulmonary infiltrate in neutropenic patients is potentially life-threatening, and requires early diagnosis and treatment. Bronchoscopic sampling is an established form of investigation in such patients.

Aim: The aim of the study is to determine the diagnostic yield and complication rate of bronchoscopic sampling in patients with a haematological disorder presenting with febrile neutropenia and pulmonary infiltrate.

Methods: Medical records and laboratory investigations were retrospectively reviewed for all patients with a haematological disorder who underwent flexible bronchoscopy and bronchoalveolar lavage (BAL) or bronchial washing (BW) at Auckland City Hospital, New Zealand, after presenting with febrile neutropenia and pulmonary infiltrate between January 2008 and December 2009. Demographic, clinical, radiological and microbiological data, procedure-related complications and treatment were recorded. Modifications to treatment regimens as a result of bronchoscopy and 30-day mortality were recorded.

Results: Out of 678 bronchoscopies performed during this period, 26 were in patients with a haematological disorder presenting with febrile neutropenia and pulmonary infiltrate. Most patients had a haematological malignancy (19/26). Two (7.7%) patients reported minor haemoptysis. No biopsies were performed. Positive microbiological samples were obtained with BAL/BW in 23% of patients. The most common organisms identified were Aspergillus species (15.4%); other organisms were Candida (11.6%) and Streptococcus pneumoniae (3.9%). The bronchoscopic results altered the clinical management of 10 (38.4%) patients. The 30-day mortality rate was 19.2%, but no deaths were related to the procedure.

Conclusions: In haematology patients presenting with febrile neutropenia and pulmonary infiltrate, bronchoscopy is a safe procedure that plays a significant role in management.

MeSH terms

  • Adult
  • Aged
  • Bronchoscopy / methods*
  • Female
  • Fever / diagnosis*
  • Fever / epidemiology
  • Hematologic Diseases / diagnosis*
  • Hematologic Diseases / epidemiology
  • Hematologic Diseases / pathology
  • Humans
  • Male
  • Middle Aged
  • Neutropenia / diagnosis*
  • Neutropenia / epidemiology
  • Neutropenia / pathology
  • Respiratory Tract Infections / diagnosis*
  • Respiratory Tract Infections / epidemiology
  • Retrospective Studies