title: Does molecular analysis increase the efficacy of bronchoalveolar lavage in the diagnosis and management of respiratory infections in hemato-oncological patients?
abstract: OBJECTIVE
  The identification of the specific pathogen responsible for a respiratory infection in patients with hematological malignancies (HM) would ensure relevant treatment and prevent toxicity associated with anti-infective therapy. This large-scale study aimed to explore the clinical impact of fiberoptic bronchoscopy with bronchoalveolar lavage (FOB-BAL) in conjunction with molecular analysis on the diagnosis and management of respiratory infections in hemato-oncological patients.
  
  
  METHODS
  All consecutive patients with HM and pulmonary infiltrates, who underwent FOB-BAL between January 2008 and January 2013, were included in the analysis. Clinical characteristics, FOB-BAL results, and treatment adjustments were recorded, and factors predicting a positive BAL were assessed.
  
  
  RESULTS
  Four hundred and twenty-five FOB-BAL procedures were analyzed. BAL revealed a specific diagnosis in 219 (51.5%) patients, 208 of them with a pulmonary infection. Infectious etiological agents found were mainly Aspergillus spp (n=142), bacterial species (n=44), and Pneumocystis jirovecii (n=34). Multivariate analysis showed that a lymphoproliferative disease, ≥2 symptoms (dyspnea/cough/hemoptysis/pleuritic pain), and less than 4 days between symptom appearance and FOB-BAL, predicted a positive FOB-BAL result. BAL results prompted a treatment modification in 48% of subjects.
  
  
  CONCLUSIONS
  FOB-BAL in conjunction with molecular assays is efficient in the rapid detection of life-threatening infections, allowing for adjustment of anti-infective therapy, which may result in better outcomes and reduce treatment-related toxicity.
authors.affiliation: Unit of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel; The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Ilana
authors.initials: I
authors.lastname: Oren
authors.affiliation: The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Division of Pulmonary Medicine, Rambam Health Care Campus, 8 Ha'Aliya Street, Haifa 31096, Israel. Electronic address: e_hardak@rambam.health.gov.il.
authors.forename: Emilia
authors.initials: E
authors.lastname: Hardak
authors.affiliation: The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Tsila
authors.initials: T
authors.lastname: Zuckerman
authors.affiliation: Clinical Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Yuval
authors.initials: Y
authors.lastname: Geffen
authors.affiliation: The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Hoffman
authors.affiliation: The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Division of Pulmonary Medicine, Rambam Health Care Campus, 8 Ha'Aliya Street, Haifa 31096, Israel.
authors.forename: Mordechai
authors.initials: M
authors.lastname: Yigla
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Irit
authors.initials: I
authors.lastname: Avivi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D018893:Bronchoalveolar Lavage / Q000379:methods*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D005658:Fungi / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D055815:Young Adult
keywords: Fiberoptic bronchoscopy with bronchoalveolar lavage; Hematological malignancies; Molecular analysis; Respiratory infections