1557. Diagnostic Yield of Bronchoalveolar Lavage in Immunocompromised Children
Session: Poster Abstract Session: Infections in the Immunocompromised Hosts
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • Nadimpalli_IDSA_2013_FINAL_PDF.pdf (204.8 kB)
  • Background: Identifying pulmonary pathogens causing disease in immunosuppressed children can improve therapeutic interventions and infection control practices. While bronchoalveolar lavage (BAL) in adults and non-suppressed children has a diagnostic yield of 30-40%, the yield in the immunosuppressed pediatric population has not been well studied.

    Methods: A retrospective review of BALs obtained for presumptive infection from 2001-2012 was performed in children ≤18 years who were pre- or post-hematopoietic stem cell transplant (HSCT) and/or with other immunosuppressive conditions. Coagulase-negative staphylococci (CoNS) or yeast without radiographic findings consistent with fungal pneumonia were excluded as contaminants.

    Results: 123 subjects (mean age 9.5y, range 0.4-18.7) underwent BAL, of whom 78 (63.4%) were male and 93 (75.6%) were HSCT recipients. Underlying diagnoses included leukemia (n=57), aplastic anemia (n=12), non-Hodgkin lymphoma (n=10), hemophagocytic lymphohistiocytosis (n=8), sickle cell disease (n=7), other oncologic (n=17) and non-oncologic conditions (n=12). Mean time from HSCT to BAL was 127 days (range 1-625). In all, 29 (23.5%) of 123 BALs were positive for ≥1 probable pathogen (n=35 organisms). Bacteria, viruses, fungi, or non-tuberculous mycobacteria (NTM) were recovered from 12, 12, 6 and 3 BAL specimens, respectively, and 2 BAL specimens were consistent with Pneumocystis jiroveci. There was no difference in overall diagnostic yield or type of organism between subjects with and without HSCT (p=0.56). Most organisms isolated within 30 days after HSCT did not differ from those isolated afterwards; all NTM were isolated >30 days post-HSCT. When comparing 2001-2006 vs. 2007-2012, the overall yield was higher in 2001-2006 (p=0.009), as was the yield of NTM (p=0.06).

    Conclusion: Diagnostic yield of BAL in immunosuppressed children was much lower than previously described in other populations. Graft-versus-host disease and pulmonary fibrosis may account for some cases of non-diagnostic BAL in the post-HSCT population. HSCT did not increase the likelihood of isolating a pathogen. Newer, molecular techniques should be studied to determine the impact on BAL yield in the immunosuppressed pediatric population.

    Sruti Nadimpalli, MD MPH, Marc Foca, MD, Prakash Satwani, MD and Lisa Saiman, MD, MPH, FSHEA, Columbia University College of Physicians & Surgeons, New York, NY


    S. Nadimpalli, None

    M. Foca, None

    P. Satwani, None

    L. Saiman, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.