Role of flexible bronchoscopy in the management of patients with febrile neutropenia and lung infiltrates in a cancer setting hospital

<b>Objective:</b> To determine the diagnostic yield of flexible bronchoscopy in determining etiology of lung infiltrates in febrile neutropenic (FN) patients and its impact on management of such patients. <b>Methods:</b> After acquiring data of total 492 patients who underwent flexible bronchoscopy in the period from July 2015 to September 2017 at Shaukat Khanum Memorial Cancer Hospital Lahore, we shortlisted 90 patients with FN. Appropriate demographic, clinical and therapeutic information was collected by detailed analysis of their medical records. <b>Results:</b> 65% (n=58) patients were male, mean age of all patients was 25 + 18 years. 67% (n=60) had Leukaemia, 19% (n=17) had Lymphoma and remaining 14% (n=13) were with solid organ malignancies. The mean absolute neutrophil count was 0.20 + 0.36x10³/µl. Prior cultures including blood and sputum cultures were positive in 27% (n=24) patients. All patients were receiving empirical antimicrobials; 36% (n=32) antibacterial alone and 64% (n=58) both antibacterial and antifungal therapy. BAL cultures were diagnostic in 44 % (n=40) patients. Aetiology was bacterial, fungal and mixed in 27/40, 12/40, and 01/40 patients respectively. The culture results of BAL led to the change of antibiotics in 58 % (52/90) of patients which was either a change or de-escalation of empirical therapy; of which 41/52 (79%) were discharged within 30 days. Post procedure respiratory distress was reported in 02/90 (2.2%) patients. <b>Conclusion:</b> Flexible bronchoscopy offers a safe and reasonably accurate diagnostic tool in order to optimise the management of FN patients with lung infiltrates.