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Letter to the Editor
Bronchoscopy with bronchoalveolar lavage: determinants of yield and impact on management in immunosuppressed patients
  1. Robert Matthew Kottmann1,
  2. Jennifer Kelly2,
  3. Elizabeth Lyda3,
  4. Michael Gurell3,
  5. Jennifer Stalica3,
  6. Wayne Ormsby3,
  7. Karoline Moon3,
  8. David Trawick3,
  9. Patricia J Sime4
  1. 1University of Rochester Medical Center, Division of Pulmonary and Critical Care Medicine, Rochester New York, USA
  2. 2University of Rochester, Department of Community and Preventative Medicine, Rochester, New York, USA
  3. 3University of Rochester, Department of Medicine, Rochester, New York, USA
  4. 4University of Rochester, Department of Medicine, Department of Environmental Medicine Rochester, and the Lung Biology and Disease Program, Rochester, New York, USA
  1. Correspondence to Robert Matthew Kottmann, University of Rochester Medical Center, Division of Pulmonary and Critical Care Medicine, 601 Elmwood Avenue, Box 692, Rochester, NY 14642, USA; matt_kottmann{at}

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Fibreoptic bronchoscopy with bronchoalveolar lavage (FOB/BAL) is a common modality for the evaluation of pulmonary infiltrates.1 2 We recognised there are limitations of comparison between subgroups of immunosuppressed patients, non-uniform definitions of a positive yield, suboptimal description of the impact of concurrent antimicrobial use at the time of the bronchoscopy and sometimes insufficient assessment of management decisions surrounding FOB/BAL.3–5 To address these issues, we performed a retrospective analysis of 190 immunosuppressed patients who underwent FOB/BAL for a pulmonary abnormality (clinical or radiographic) at the University of Rochester Medical Center from 2005 to 2008. A positive yield was defined as one of the following: (1) positive culture—bacterial, viral or fungal (not including Candida albicans alone); (2) positive finding on cytopathology or fungal stain; or (3) diffuse alveolar haemorrhage. Antimicrobial and corticosteroid treatment changes …

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