title: Microbiologic yield of bronchoalveolar lavage specimens from stem cell transplant recipients.
abstract: OBJECTIVE
  Stem cell transplant (SCT) recipients commonly undergo bronchoalveolar lavage (BAL) collection as an infectious pulmonary work-up. Previous studies report the utility and overall diagnostic yield of fiberoptic bronchoscopy with BAL in this vulnerable population, though none focused purely on microbiologic yield or made comparisons with less invasive means of pathogen detection. We sought to determine and elaborate on the microbiologic yield of BAL in SCT recipients, assess a correlation between BAL studies and less invasive means of pathogen detection, and assess the utility of repeating a BAL within 30 days.
  
  
  METHODS
  Between January 1, 2009, and July 31, 2013, we reviewed medical records of 125 SCT recipients who underwent 179 BALs. In addition to demographic information and details pertaining to their SCT, a comprehensive review of their microbiologic data was performed and recorded.
  
  
  RESULTS
  Our study showed an overall BAL microbiologic yield of 40%, despite 92% of patients receiving broad-spectrum antimicrobial therapy at the time of the BAL procedure.
  
  
  CONCLUSIONS
  Although an initial BAL sample in this population provides crucial microbiologic information, repeating the procedure within 30 days may have minimal additional microbiologic yield. BAL continues to be an essential diagnostic tool in SCT recipients undergoing an infectious pulmonary work-up.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Sakata
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Klassen
authors.affiliation: Division of Hematology and Oncology, Scripps Green Hospital, La Jolla, CA, USA.
authors.forename: Kathryn B
authors.initials: KB
authors.lastname: Bollin
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Grys
authors.affiliation: Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Slack
authors.affiliation: Division of Pulmonary Medicine, Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: Lewis J
authors.initials: LJ
authors.lastname: Wesselius
authors.affiliation: Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ, USA.
authors.forename: Holenarasipur R
authors.initials: HR
authors.lastname: Vikram
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018893:Bronchoalveolar Lavage / Q000295:instrumentation / Q000379:methods; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D001999:Bronchoscopy / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000382:microbiology* / Q000517:prevention & control; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous / Q000009:adverse effects; D014184:Transplantation, Homologous / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents
keywords: bone marrow transplant; bronchoalveolar lavage; fiberoptic bronchoscopy; immunocompromised; immunosuppressed; stem cell transplant