DOI: 10.32322/jhsm.2012778 ISSN: 2636-8579

Microbiological diagnostic yield and clinical predictors of bronchoalveolar lavage in hematopoietic stem cell transplant recipients

Ezgi Erdem Türe, Melike Ak Ayaroğlu, Ceren Kılıç, Derya Doğan, Asena Dikyar, Oğuz Alp Gürbüz, Emine Bahar Kurt
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Aims: Bronchoalveolar lavage (BAL) is widely used to identify causative pathogens and guide antimicrobial therapy in hematopoietic stem cell transplant (HSCT) recipients; however, the factors associated with microbiological positivity remain poorly defined. This study aimed to evaluate the microbiological diagnostic yield of BAL, its impact on antimicrobial management, and the clinical factors associated with microbiological positivity.Methods: This retrospective observational study included 49 HSCT recipients who underwent 61 bronchoscopic BAL procedures. Demographic, clinical, radiological, laboratory, microbiological, and procedural data were collected from electronic medical records. Clinical characteristics were compared according to BAL microbiological positivity. Univariate and multivariable logistic regression analyses were performed to identify factors associated with microbiological positivity.Results: BAL microbiological positivity was detected in 28 of 61 procedures (45.9%). Ground-glass opacities and consolidation were the predominant chest CT findings. Aspergillus fumigatus complex was the most frequently isolated organism in culture, while galactomannan assay positivity and cytomegalovirus PCR detection were the most common positive microbiological test results. Antimicrobial therapy was modified following bronchoscopy in 29 procedures (47.5%) and occurred significantly more frequently in BAL-positive than BAL-negative cases (64.3% vs. 33.3%, p=0.016). Neither bronchoscopy indication, predominant chest CT pattern, neutropenia, ongoing antimicrobial therapy, nor BAL sample acceptance time was associated with microbiological positivity. Bronchoscopy-related complications occurred in only two procedures (3.3%), both consisting of minor bleeding.Conclusion: BAL provides an acceptable microbiological diagnostic yield with a low complication rate in HSCT recipients and has a substantial impact on antimicrobial management.

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