Respiratory Medicine, Auckland City Hospital, Auckland, New Zealand.
Intern Med J. 2012 May;42(5):536-41. doi: 10.1111/j.1445-5994.2011.02643.x.
The development of pulmonary infiltrate in neutropenic patients is potentially life-threatening, and requires early diagnosis and treatment. Bronchoscopic sampling is an established form of investigation in such patients.
The aim of the study is to determine the diagnostic yield and complication rate of bronchoscopic sampling in patients with a haematological disorder presenting with febrile neutropenia and pulmonary infiltrate.
Medical records and laboratory investigations were retrospectively reviewed for all patients with a haematological disorder who underwent flexible bronchoscopy and bronchoalveolar lavage (BAL) or bronchial washing (BW) at Auckland City Hospital, New Zealand, after presenting with febrile neutropenia and pulmonary infiltrate between January 2008 and December 2009. Demographic, clinical, radiological and microbiological data, procedure-related complications and treatment were recorded. Modifications to treatment regimens as a result of bronchoscopy and 30-day mortality were recorded.
Out of 678 bronchoscopies performed during this period, 26 were in patients with a haematological disorder presenting with febrile neutropenia and pulmonary infiltrate. Most patients had a haematological malignancy (19/26). Two (7.7%) patients reported minor haemoptysis. No biopsies were performed. Positive microbiological samples were obtained with BAL/BW in 23% of patients. The most common organisms identified were Aspergillus species (15.4%); other organisms were Candida (11.6%) and Streptococcus pneumoniae (3.9%). The bronchoscopic results altered the clinical management of 10 (38.4%) patients. The 30-day mortality rate was 19.2%, but no deaths were related to the procedure.
In haematology patients presenting with febrile neutropenia and pulmonary infiltrate, bronchoscopy is a safe procedure that plays a significant role in management.
中性粒细胞减少症患者肺部浸润的发展可能危及生命，需要早期诊断和治疗。支气管镜检查是此类患者的一种既定检查方法。
本研究旨在确定血液系统疾病患者出现发热性中性粒细胞减少症和肺部浸润时，支气管镜检查的诊断率和并发症发生率。
回顾性分析 2008 年 1 月至 2009 年 12 月期间，在新西兰奥克兰市医院因发热性中性粒细胞减少症和肺部浸润而接受支气管镜检查和支气管肺泡灌洗（BAL）或支气管冲洗（BW）的所有血液系统疾病患者的病历和实验室检查。记录人口统计学、临床、影像学和微生物学数据、与操作相关的并发症以及治疗方法。记录支气管镜检查和 30 天死亡率对治疗方案的修改。
在此期间进行的 678 次支气管镜检查中，有 26 次是在血液系统疾病患者中进行的，这些患者出现发热性中性粒细胞减少症和肺部浸润。大多数患者患有血液系统恶性肿瘤（19/26）。2 名（7.7%）患者报告有轻微咯血。未进行活检。BAL/BW 获得了 23%患者的阳性微生物样本。最常见的病原体是曲霉菌属（15.4%）；其他病原体为念珠菌（11.6%）和肺炎链球菌（3.9%）。支气管镜检查结果改变了 10 名（38.4%）患者的临床管理。30 天死亡率为 19.2%，但无死亡与该操作相关。
在出现发热性中性粒细胞减少症和肺部浸润的血液系统疾病患者中，支气管镜检查是一种安全的操作，在管理中起着重要作用。
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