TY - JOUR T1 - The role of flexible bronchoscopy in the evaluation of fever in immunocompromised haematological patients JF - European Respiratory Journal JO - Eur Respir J VL - 44 IS - Suppl 58 SP - P2579 AU - Elena Karampini AU - Theodora Vatopoulou AU - Andrew Creamer AU - Geoffrey Warwick Y1 - 2014/09/01 UR - http://erj.ersjournals.com/content/44/Suppl_58/P2579.abstract N2 - Introduction/aim: Respiratory infection is a leading cause of morbidity and death in febrile immunocompromised patients, despite the introduction of prophylactic strategies and advances in diagnosis and treatment. We aimed to evaluate the safety, diagnostic yield and therapeutic implications of flexible bronchoscopy (FB) with bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) in immunocompromised haematological patients, who present with a fever and pulmonary infiltrates. Method: We retrospectively reviewed the medical records of all such patients, who were evaluated by FB over 5 years (August 2008 - August 2013) in our hospital. Results: 102 patients with fever and pulmonary infiltrates were identified (male 59, female 43; median age 55 years). 42 patients (41.2%) had significant neutropenia (<1 x 109/L), The median time from hospital admission to FB was 10.5 days. 100 patients (98%) underwent chest computed tomography (CT) prior to FB. 86 patients (84.3%) had been on antibiotics (median course duration: 12 days) and 59 (57.8%) on antifungals prior to FB. FB (102 BAL and 3 TBB) was performed safely with only 4 patients experiencing complications (respiratory failure, pneumothorax or significant bleeding). The diagnostic yield of FB was 46%. The bronchoscopic findings resulted in management changes (confirmation of diagnosis/treatment, change of treatment agent or proceeding to further investigations) in 34.3% of patients. Conclusion: FB as a component of the septic screen in febrile patients with pulmonary infiltrates is both useful and safe. The majority of febrile immunosuppressed haematological patients are empirically treated prior to FB. ER -