Diagnostic Utility of Bronchoalveolar Lavage in Patients with Acute Leukemia under Broad-Spectrum Anti-Infective Treatment
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Population
- Aged ≥ 18 years.
- Diagnosed with either AML or acute lymphoblastic leukemia (ALL).
- Diagnosed with multi-drug resistant fever or suspected infection defined as an occurrence under >three days of empiric broad-spectrum antibiotic and empiric antifungal treatment, antiviral prophylaxis, and prophylaxis against Pneumocystis jirovecii (Figure 2).
- Underwent CT scan of the chest showing pulmonary infiltrates within five days prior to FB with BAL.
- Underwent procedure of FB with BAL.
- No previous allogeneic stem cell transplantation.
2.2. Clinical Data Collection
2.3. Procedure of Flexible Bronchoscopy and Bronchoalveolar Lavage
2.4. Microbiological Tests
2.5. Statistical Analysis
2.6. Endpoint
3. Results
3.1. Diagnostic Assessment and Clinical Courses
3.2. Microbiological Findings in BAL
3.3. Impact of BAL on Anti-Infective Treatment
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total Cohort (n = 88) | |
---|---|
Median age in years (IQR) | 59 (48–68) |
Male Sex, n (%) | 59 (67) |
Underlying disease, n (%) | |
Acute myleoid leukemia | 76 (86) |
Acute lymphoblastic leukemia | 12 (14) |
Time point of FB with BAL, n (%): | |
Prior any systemic oncological therapy | 1 (1) |
During induction cycles | 51 (58) |
During consolidation cycles | 7 (8) |
During salvage chemotherapy | 21 (24) |
During low-dose chemotherapy | 8 (9) |
Aplasia at FB with BAL, n (%): | 83 (94) |
Duration of aplasia, days (IQR) | 15 (10–25) |
High-risk neutropenia | 38 (43) |
Fever at FB with BAL, n (%) | 28 (32) |
Chest computed tomography, n (%): | 88 (100) |
Lobar pneumonia | 25 (28) |
Atypical pneumonia | 63 (72) |
Invasive ventilation <30 days after the onset of pneumonia, n (%) | 17 (19) |
Pneumonia-related death <30 days after the onset of pneumonia, n (%) | 12 (14) |
Anti-infective treatment against bacteria at FB, n (%) | 88 (100) |
Meropenem | 73 (83 |
Ceftazidim | 14 (16) |
Piperacillin/Tazobactam | 1 (1) |
Vancomycin or Linezolid | 64 (73) |
Tigecycline | 22 (25) |
Fosfomycin | 4 (5) |
Gentamicin | 3 (3) |
Daptomycin | 1 (1) |
Anti-infective treatment against fungal infection at FB, n | 88 (100) |
Amphotericin B | 68 (77) |
Caspofungin | 9 (10) |
Voriconazole | 7 (8) |
Posaconazole | 3 (4) |
Anidulafungin | 1 (1) |
Prophylaxis against Pneumocystis jirovecii (Cotrimoxazole n = 89, Pentacarinate n = 2) | 88 (100) |
Anti-infective treatment against viruses at FB, n (%) | 88 (100) |
Aciclovir prophylaxis | 88 (100) |
Oseltamivir | 2 (2) |
Pathogen Detected in BAL | Prior Anti-Infective Treatment to BAL * | Changes in Anti-Infective Treatment after BAL | |
---|---|---|---|
Case 1 | Influenza A | Meropenem, vancomycin, amphotericin B | Oseltamivir |
Case 2 | Herpes simplex virus 1 ** | Meropenem, vancomycin, amphotericin B | Adaption of aciclovir dosage |
Case 3 | Herpes simplex virus 1 ** | Meropenem, vancomycin, amphotericin B | Adaption of aciclovir dosage |
Case 4 | Herpes simplex virus 1 ** | Meropenem, vancomycin, caspofungine | Adaption of aciclovir dosage |
Case 5 | Influenza A | Meropenem, tigecycline, amphotericin B | Oseltamivir |
Case 6 | Influenza A | Ceftazidim, tigecycline, amphotericin B | Oseltamivir |
Case 7 | Herpes simplex virus 1 ** | Ceftazidim, vancomycin, amphotericin B | Adaption of aciclovir dosage |
Case 8 | Herpes simplex virus 1 ** | Meropenem, tigecycline, amphotericin B | Adaption of aciclovir dosage |
Case 9 | Herpes simplex virus 1 ** | Meropenem, vancomycin, amphotericin B | Adaption of aciclovir dosage |
Case 10 | Herpes simplex virus 1 ** and mycoplasma pneumoniae | Meropenem, linezolid, amphotericin B | Azithromycine and adaption of aciclovir dosage |
Case 11 | Herpes simplex virus 1 ** | Meropenem, tigecycline, voriconazole | Adaption of aciclovir dosage |
Case 12 | Herpes simplex virus 1 ** and pneumocystis spp. | Meropenem, tigecycline, amphotericin B | Adaption of aciclovir and cotrimoxazole dosage |
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Ghandili, S.; von Kroge, P.H.; Simon, M.; Henes, F.O.; Rohde, H.; Hoffmann, A.; Lindeman, N.B.; Bokemeyer, C.; Fiedler, W.; Modemann, F. Diagnostic Utility of Bronchoalveolar Lavage in Patients with Acute Leukemia under Broad-Spectrum Anti-Infective Treatment. Cancers 2022, 14, 2773. https://doi.org/10.3390/cancers14112773
Ghandili S, von Kroge PH, Simon M, Henes FO, Rohde H, Hoffmann A, Lindeman NB, Bokemeyer C, Fiedler W, Modemann F. Diagnostic Utility of Bronchoalveolar Lavage in Patients with Acute Leukemia under Broad-Spectrum Anti-Infective Treatment. Cancers. 2022; 14(11):2773. https://doi.org/10.3390/cancers14112773
Chicago/Turabian StyleGhandili, Susanne, Philipp H. von Kroge, Marcel Simon, Frank O. Henes, Holger Rohde, Armin Hoffmann, Nick Benjamin Lindeman, Carsten Bokemeyer, Walter Fiedler, and Franziska Modemann. 2022. "Diagnostic Utility of Bronchoalveolar Lavage in Patients with Acute Leukemia under Broad-Spectrum Anti-Infective Treatment" Cancers 14, no. 11: 2773. https://doi.org/10.3390/cancers14112773