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2689. Utility of Bronchoalveolar Lavage for Diagnosis and Management of Pneumonia in Immunocompromised Children

BACKGROUND: Determining the etiology of acute respiratory illness (ARI) in immunocompromised children is challenging. The wide variety of infectious and non-infectious causes makes it difficult to optimize empiric antimicrobial treatments, leading to broad, lengthy antimicrobial courses with potenti...

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Autores principales: Green, Amanda M, Flerlage, Tim, Hijano, Diego, Abraham, Afreen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10678570/
http://dx.doi.org/10.1093/ofid/ofad500.2300
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author Green, Amanda M
Flerlage, Tim
Hijano, Diego
Abraham, Afreen
author_facet Green, Amanda M
Flerlage, Tim
Hijano, Diego
Abraham, Afreen
author_sort Green, Amanda M
collection PubMed
description BACKGROUND: Determining the etiology of acute respiratory illness (ARI) in immunocompromised children is challenging. The wide variety of infectious and non-infectious causes makes it difficult to optimize empiric antimicrobial treatments, leading to broad, lengthy antimicrobial courses with potential antimicrobial overuse, increased side effects, and interruptions to chemotherapy treatments. The diagnostic yield and safety of bronchoalveolar lavage (BAL) in these patients has long been debated. METHODS: We conducted a retrospective chart review of BAL procedures performed on immunocompromised children with ARI at St. Jude Children’s Research Hospital between 2017-2021. Microbiological and molecular study results were reviewed, including next generation sequencing (NGS) studies obtained from BAL, upper respiratory, and blood specimens within 7 days of the BAL. Etiology determined by the clinical team, changes in antimicrobial clinical management, and adverse events following the BAL were collected. RESULTS: 82 BAL procedures from 57 patients are presented. The most common underlying diagnosis was hematologic malignancy, and 39 (48%) had undergone hematopoietic cell transplant. BAL identified one or more potential respiratory pathogen in 62.2% of ARIs, including viruses (54%), bacteria (48%), and fungi (37%). Of the 12 patients with BAL NGS, 8 (67%) identified likely respiratory pathogens, 5 (42%) correlated with other testing, and 3 (25%) were unique to NGS. 58 (71%) of BALs led to a change in antimicrobial management, either by discontinuation of broad-spectrum antimicrobials (65%) or narrowed antimicrobial regimen (41%). In 7 (12%) patients with suspected infectious etiology, BAL confirmed alternate etiology and avoided initiation of antimicrobials. 12 (15%) of patients underwent new intubation, and 22 (27%) had increased ventilatory requirements within 24 hours of BAL. No patients required new ICU transfer due to the procedure. [Figure: see text] [Figure: see text] CONCLUSION: BAL is a valuable, well tolerated procedure that can aid in the diagnosis of pulmonary disease in pediatric immunocompromised patients. These preliminary findings highlight the benefits of BAL and its potential impact on decision making and clinical management, including avoiding antimicrobial overuse. DISCLOSURES: All Authors: No reported disclosures
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spelling pubmed-106785702023-11-27 2689. Utility of Bronchoalveolar Lavage for Diagnosis and Management of Pneumonia in Immunocompromised Children Green, Amanda M Flerlage, Tim Hijano, Diego Abraham, Afreen Open Forum Infect Dis Abstract BACKGROUND: Determining the etiology of acute respiratory illness (ARI) in immunocompromised children is challenging. The wide variety of infectious and non-infectious causes makes it difficult to optimize empiric antimicrobial treatments, leading to broad, lengthy antimicrobial courses with potential antimicrobial overuse, increased side effects, and interruptions to chemotherapy treatments. The diagnostic yield and safety of bronchoalveolar lavage (BAL) in these patients has long been debated. METHODS: We conducted a retrospective chart review of BAL procedures performed on immunocompromised children with ARI at St. Jude Children’s Research Hospital between 2017-2021. Microbiological and molecular study results were reviewed, including next generation sequencing (NGS) studies obtained from BAL, upper respiratory, and blood specimens within 7 days of the BAL. Etiology determined by the clinical team, changes in antimicrobial clinical management, and adverse events following the BAL were collected. RESULTS: 82 BAL procedures from 57 patients are presented. The most common underlying diagnosis was hematologic malignancy, and 39 (48%) had undergone hematopoietic cell transplant. BAL identified one or more potential respiratory pathogen in 62.2% of ARIs, including viruses (54%), bacteria (48%), and fungi (37%). Of the 12 patients with BAL NGS, 8 (67%) identified likely respiratory pathogens, 5 (42%) correlated with other testing, and 3 (25%) were unique to NGS. 58 (71%) of BALs led to a change in antimicrobial management, either by discontinuation of broad-spectrum antimicrobials (65%) or narrowed antimicrobial regimen (41%). In 7 (12%) patients with suspected infectious etiology, BAL confirmed alternate etiology and avoided initiation of antimicrobials. 12 (15%) of patients underwent new intubation, and 22 (27%) had increased ventilatory requirements within 24 hours of BAL. No patients required new ICU transfer due to the procedure. [Figure: see text] [Figure: see text] CONCLUSION: BAL is a valuable, well tolerated procedure that can aid in the diagnosis of pulmonary disease in pediatric immunocompromised patients. These preliminary findings highlight the benefits of BAL and its potential impact on decision making and clinical management, including avoiding antimicrobial overuse. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2023-11-27 /pmc/articles/PMC10678570/ http://dx.doi.org/10.1093/ofid/ofad500.2300 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstract
Green, Amanda M
Flerlage, Tim
Hijano, Diego
Abraham, Afreen
2689. Utility of Bronchoalveolar Lavage for Diagnosis and Management of Pneumonia in Immunocompromised Children
title 2689. Utility of Bronchoalveolar Lavage for Diagnosis and Management of Pneumonia in Immunocompromised Children
title_full 2689. Utility of Bronchoalveolar Lavage for Diagnosis and Management of Pneumonia in Immunocompromised Children
title_fullStr 2689. Utility of Bronchoalveolar Lavage for Diagnosis and Management of Pneumonia in Immunocompromised Children
title_full_unstemmed 2689. Utility of Bronchoalveolar Lavage for Diagnosis and Management of Pneumonia in Immunocompromised Children
title_short 2689. Utility of Bronchoalveolar Lavage for Diagnosis and Management of Pneumonia in Immunocompromised Children
title_sort 2689. utility of bronchoalveolar lavage for diagnosis and management of pneumonia in immunocompromised children
topic Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10678570/
http://dx.doi.org/10.1093/ofid/ofad500.2300
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