title: Utility of flexible bronchoscopy in the evaluation of pulmonary infiltrates in the hematopoietic stem cell transplant population -- a single center fourteen year experience.
abstract: BACKGROUND
  Pulmonary infiltrates are common within the hematopoietic stem cell transplant (HSCT) population and unfortunately portend an increased mortality. Bronchoscopy is often utilized as an initial diagnostic tool, but the literature supporting its diagnostic utility and effect on clinical management varies significantly. The aim of this study was to investigate the diagnostic ability, complication rate, and clinical impact of flexible bronchoscopy (FB) in evaluating pulmonary infiltrates in a large HSCT population.
  
  
  METHODS
  Retrospective review of all patients undergoing FB after HSCT in the Bone Marrow Transplant Unit from 1996 to 2009.
  
  
  RESULTS
  FB was performed 162times in 144patients with pulmonary infiltrates yielding positive results in 52.5%. The most common positive results were bacterial pneumonia (31%), fungal pneumonia (15%), and alveolar hemorrhage (11%). Treatment changes occurred in 44% of patients after FB. Treatment changes included antibiotic modification (59%), addition of corticosteroids (21%), antifungal modification (12%), and antiviral modification (7%). The overall complication rate associated with FB was 30%, although 84% of these complications were considered minor.
  
  
  CONCLUSIONS
  FB in patients with pulmonary infiltrates after HSCT should still be considered a valuable tool in the evaluation and management of pulmonary infiltrates in the HSCT population. Future prospective, multicenter randomized studies are needed to evaluate the overall clinical impact that bronchoscopic results and management changes have in this unique population.
authors: Milton S. Hershey Medical Center, Pennsylvania School University School of Medicine, Hershey, PA, USA. cgilbert1@hmc.psu.edu
authors: Christopher R
authors: CR
authors: Gilbert
authors: Andrew
authors: A
authors: Lerner
authors: Michael
authors: M
authors: Baram
authors: Bharat K
authors: BK
authors: Awsare
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D064591:Allografts; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001706:Biopsy; D001986:Bronchial Spasm / Q000209:etiology; D001992:Bronchoalveolar Lavage Fluid; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000601:surgery; D018380:Hematopoietic Stem Cell Transplantation; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D008171:Lung Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D008297:Male; D009101:Multiple Myeloma / Q000150:complications / Q000601:surgery; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D014182:Transplantation, Autologous
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000998:Antiviral Agents