| Therapeutic implication of BAL in patients with neutropenia. | |
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MedLine Citation:
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PMID: 19415277 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Bronchoalveolar lavage (BAL) is a practicable procedure establishing the etiology of pneumonia. In patients with neutropenia, empirical antimicrobial treatment is mandatory immediately after diagnosis of infection, usually before results of BAL are available. We evaluated the impact of BAL on treatment and outcome of pneumonia in immunocompromised patients with a special regard to neutropenia. Bronchoscopy with BAL was performed in 58 episodes of clinical documented pneumonia in patients with hematological malignancies (88%) or solid tumors (12%), in 30 cases patients had neutropenia, in 28 cases patients had no neutropenia. In 93% of cases, BAL was performed under empirical antimicrobial treatment. BAL fluid was cultivated for bacteria, fungi, and tested for Pneumocystis jirovecii and cytomegalovirus (CMV). BAL revealed positive bacterial results in 67% of cases. Gram-positive microorganisms were detected in 95% of positive BAL results, gram-negative microorganisms in 23%, mixed bacterial cultures occurred in 41%. Positive fungi cultures were found in 59%. P. jirovecii was detected in 5% of cases tested and CMV in 8%. There was no significant difference between neutropenic and non-neutropenic patients. BAL results directed a change of therapy in only six of 58 episodes (5%). Overall mortality related to pneumonia was 16%. In this patient setting, the yield of BAL rarely has a significant influence on treatment and outcome of pneumonia. The early beginning of antimicrobial treatment reduces the diagnostic yield of BAL. In patients with pneumonia during neutropenia, its use should be well considered. |
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Authors:
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Dagmar Kuehnhardt; Manja Hannemann; Bernd Schmidt; Ulrike Heider; Kurt Possinger; Jan Eucker |
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Publication Detail:
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Type: Journal Article Date: 2009-05-05 |
Journal Detail:
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Title: Annals of hematology Volume: 88 ISSN: 1432-0584 ISO Abbreviation: Ann. Hematol. Publication Date: 2009 Dec |
Date Detail:
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Created Date: 2009-10-19 Completed Date: 2009-11-23 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9107334 Medline TA: Ann Hematol Country: Germany |
Other Details:
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Languages: eng Pagination: 1249-56 Citation Subset: IM |
Affiliation:
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Department of Oncology and Hematology, University Hospital Charité, 10117 Berlin, Germany. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Anti-Bacterial Agents / therapeutic use* Bronchoalveolar Lavage* Female Humans Immunocompromised Host* Male Middle Aged Neoplasms / blood, complications, microbiology Neutropenia / blood*, complications, etiology, microbiology* Pneumonia / drug therapy*, etiology, microbiology* Retrospective Studies Treatment Outcome Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Anti-Bacterial Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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