Chest
Volume 117, Issue 2, February 2000, Pages 573-577
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Bronchoscopy
A Prospective Study of Fever and Bacteremia After Flexible Fiberoptic Bronchoscopy in Children

https://doi.org/10.1378/chest.117.2.573Get rights and content

Study objectives

To assess the incidence of fever and bacteremia after fiberoptic bronchoscopy in immunocompetent children.

Design

Prospective study.

Patients

Immunocompetent children undergoing fiberoptic bronchoscopy between January 1997 and June 1998.

Measurements and results

Ninety-one children were included in the study. Forty-four children (48%) developed fever within 24 h following bronchoscopy. Bacteremia was not detected in any of the cases at the time of the fever. Children who developed fever were younger than those who remained afebrile (mean age, 2.4 ± 3.6 years vs 4.2 ± 3.7 years; p = 0.025). In the fever group, 66% of the bronchoscopies were considered abnormal, compared to 45% in the nonfever group (p = 0.04). Of the fever group, 40.5% of BAL fluid cultures had significant bacterial growth, significantly higher compared to the nonfever group (13.2%; p = 0.006). Of the 80 patients in whom BAL was performed, fever occurred in 52.5% compared to only 18.2% in those who did not have BAL (p = 0.03). BAL fluid content of cell count, lipid-laden macrophages, and interleukin-8 were not significantly different in both groups. In a logistic regression analysis, the significant predictors for developing fever were positive bacterial culture (relative risk, 5.1; 95% confidence interval, 1.6 to 16.4; p = 0.007) and abnormal bronchoscopic findings (relative risk, 3.1, 95% confidence interval, 1.2 to 8.3; p = 0.02). When age < 2 years was included in the model, this factor became highly significant (relative risk, 5.01; 95% confidence interval, 1.83 to 13.75; p < 0.002).

Conclusions

Fever following fiberoptic bronchoscopy is a common event in immunocompetent children and is not associated with bacteremia. Risks to develop this complication are age < 2 years, positive bacterial cultures in BAL fluid, and abnormal bronchoscopic findings.

Section snippets

Materials and Methods

Children undergoing FB between January 1997 and June 1998 in the Pediatric Respiratory Unit at the Shaare Zedek Medical Center were enrolled in the study. Exclusion criteria were as follows: immunocompromised state, concurrent treatment with antibiotics or systemic steroids, fever > 38°C during the 48 h prior to bronchoscopy, or bronchoscopy performed late in the day rendering strict follow-up impossible. Informed consent was obtained from the parents of each patient enrolled in the study. All

Results

Of the 130 children who underwent FB in our department during the study period, 91 were entered in the study. Those excluded either had fever before the procedure, were receiving antibiotic therapy, or were immunodeficient. Indications for FB included stridor (19 cases), BAL for bacteriology and cytology (19 cases), upper airway obstruction (14 cases), recurrent pneumonia (11 cases), suspected foreign body aspiration (9 cases), atelectasis (9 cases), persistent wheezing (5 cases), hoarse voice

Discussion

In this prospective study, nearly half of the children who underwent FB developed fever within 24 h after the procedure. Postbronchoscopy fever was associated with younger age (mainly < 2 years), presence of significant bacterial growth from BALF, and abnormal bronchoscopic findings. Bacteremia was not detected in any of the cases in our study. Furthermore, recurrent aspiration was not found to be a risk factor for developing fever.

To the best of our knowledge, no prospective study of fever

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