title: Utility of bronchoalveolar lavage in the diagnosis of pulmonary infection in children with haematological malignancies.
abstract: BACKGROUND
  Fibre-optic bronchoscopy with bronchoalveolar lavage (BAL) is a safe procedure and is associated with low morbidity and mortality in immunocompromised children. Although many studies have highlighted the advantages of positive BAL results in the diagnosis of pulmonary infections, there have been few reports examining the impact of a negative BAL result on clinical management in immunocompromised children on empiric broad-spectrum antimicrobial therapy.
  
  
  OBJECTIVE
  The aim of this study was to evaluate BAL in the diagnosis of pulmonary infections in children with haematological malignancies who develop pneumonia unresponsive to empiric antimicrobial therapy, and also to determine whether a negative BAL result contributed to the clinical management of these patients.
  
  
  METHODS
  A retrospective review of 44 BAL procedures performed in 33 children with haematological malignancy diagnosed and treated at Our Lady's Children Hospital, Crumlin, Dublin 12, Ireland, over a 10-year period was carried out.
  
  
  RESULTS
  We identified a pathogen causing pneumonia in 24 of 44 BAL procedures (54.5 %). The BAL procedure resulted in modification of antimicrobial treatment after 20 of 24 procedures with positive results (83.3 %) in 16 of 20 patients (80 %). Management was changed after 8 of 20 procedures with negative results (40 %) in 8 of 18 patients (44.4 %). The procedure was well tolerated in all patients.
  
  
  CONCLUSIONS
  Our study supports the use of bronchoscopy with BAL as a diagnostic intervention in this patient population. We consider BAL a safe procedure from which both positive and negative results contribute to the patient's clinical management.
authors.affiliation: Department of Haematology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
authors.forename: U
authors.initials: U
authors.lastname: Rao
authors.forename: A
authors.initials: A
authors.lastname: Piccin
authors.forename: A
authors.initials: A
authors.lastname: Malone
authors.forename: K
authors.initials: K
authors.lastname: O'Hanlon
authors.forename: F
authors.initials: F
authors.lastname: Breatnach
authors.forename: A
authors.initials: A
authors.lastname: O'Meara
authors.forename: M
authors.initials: M
authors.lastname: McDermott
authors.forename: K
authors.initials: K
authors.lastname: Butler
authors.forename: N
authors.initials: N
authors.lastname: O'Sullivan
authors.forename: J
authors.initials: J
authors.lastname: Russell
authors.forename: A
authors.initials: A
authors.lastname: O'Marcaigh
authors.forename: O P
authors.initials: OP
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006776:Hospitals, Pediatric; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007494:Ireland; D007938:Leukemia / Q000150:complications; D008223:Lymphoma / Q000150:complications; D008297:Male; D011014:Pneumonia / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D012189:Retrospective Studies
chemical_list: D000890:Anti-Infective Agents