Source: DGNews  |  Posted 2 years ago

By Cathy Yarbrough

SAN DIEGO -- May 20, 2009 -- In severely immunocompromised patients with febrile neutropenia (FN), early use of flexible bronchoscopy (FB) is feasible and safe, according to a study presented here on May 18 at the International Conference of the American Thoracic Society (ATS).

In addition, the fungal yield is higher in early FB treated patients than in patients receiving standard care.

Chien-Li Liew, Royal Adelaide Hospital, Adelaide, Australia, and colleagues, conducted the prospective, randomised study to determine whether severely immunocompromised patients should undergo FB before they develop clinical or radiological indications of FN.

They hypothesised that early FB may improve patient outcomes by increasing diagnostic yield and reducing the risk of procedural complications caused by advanced respiratory infections.

A total of 31 patients with acute leukaemia or allogeneic bone marrow transplantation were randomised to receive early FB treatment (n = 14) or conventional care (CC; n = 17).

After 4 weeks, significantly high fungal growth was detected in the early FB treatment group (5/12) compared with the CC group (0/7; P < .05). The researchers noted that this large yield was not predicted by clinical or radiological changes.

The researchers observed 31 episodes of FN in the 2 patient groups (17 in the CC group and 14 in the early FB patient group).

During the study, 19 FB procedures were performed -- 7 in the CC group and 12 in the early FB group.

Mean time from FN to FB was 240 and 10.6 hours in the conventional management and early FB groups respectively, with higher mean total doses of antibiotics administered to the CC group. Procedural complications did not occur in either group.

The mean oxygen saturation post-FB was higher in the early FB group (mean 96.7 vs 90.4, P = .02).

In the CC group, 1-year survival after FN was 47% versus 57% in the early FB group.

Funding for this study was provided by the Royal Adelaide Hospital Research Grant.

[Presentation title: Utility of Flexible Bronchoscopy in Severely Immunocompromised Febrile Neutropenic Patients. Poster 709]