impact of bronchoalveolar lavage on the management of immunocompromised hosts

Introduction Respiratory infections are an important cause of morbidity and mortality in immunocompromised individuals. Fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) is an important tool to assess the role played by infectious agents in immunocompromised patients with lower respiratory tract infections (LRTI).

Hypothesis We hypothesize that BAL may influence the management of immunocompromised patients with suspicion of LRTI and we aimed to quantify its impact up to 30 days after bronchoscopy.

Methods Immunocompromised patients with a suspicion for LRTI underwent diagnostic BAL. The primary composite outcome consisted of pre-defined modifications in the management of the immunocompromised patients following BAL.

Results A total of 2,666 visits from 1,301 patients were included in this observational, single-center study performed at the University Hospital Basel, Switzerland between October 2009 and September 2017. Immunosuppression was classified as haematological (n= 1,040; 544 patients), solid organ transplantation (n= 666; 107 patients) and other causes (n= 960; 650 patients). BAL led to a change in management in 52.36% (n= 1,396). This percentage, as well as the 30-day mortality, differed significantly among the three groups. Age, C-reactive protein (CRP) levels and etiology of infection significantly affected 30-day mortality. In 1.89% (n= 50) a combination of 2 infectious agents was found and 92.68% (n= 646) were diagnosed with a single respiratory viral agent.

Conclusions BAL leads to changes in management in the majority of immunosuppressed patients. There is a high prevalence of multimicrobial infections and respiratory virus infections in immunocompromised patients with respiratory symptoms. Individual virus infection is associated with different risks of negative outcomes.

Publication History

Article published online:
01 March 2024