Original Article

Incidence of Fever and Bacteriemia Following Flexible Fiberoptic Bronchoscopy: A Prospective Study

Abstract

The latest American Heart Association (AHA) statement for preventing infectious endocarditis, has not recommended prophylactic antibiotic therapy prior to fiberoptic bronchoscopy (FB) except for patients with preexisting predisposing cardiac conditions. Our aim was to determine the incidence of bacteriemia and fever following FB in our experience and compare with those which have been mentioned in AHA guideline as well as other studies. Venous blood of 85 consecutive patients was evaluated for both aerobic and anaerobic cultures before (for detecting possible previous bacteriemia) and after FB. None of the patients were treated with antibiotics prior to the procedure. All the patients were examined during the first 24 hours after FB for detecting fever defined as temperature more than 38 °C. Positive hemocultures were noted in 7 (8.2 %) patients after FB examination. Coagulase negative Staphylococcus, coagulase positive Staphylococcus, beta haemolytic Streptococcus, Citrobacter freundii and Streptococcus viridans were found in 4, 1, 1 and 1 cultures of patients, respectively. By excluding 6 contaminated samples, the rate of bacteriemia reduced to 1 (1.1%) patient in whom the identical pathogen (Streptococcus viridans) was found both in bronchial lavage and venous blood culture. We also found fever in 9 (10.5 %) cases in the first 24 hours following the bronchoscopy. Our results were in consistent with AHA recommendations regarding prevention of infectious endocarditis as a practical gridline in patients who schedule for FB. Besides, transient fever following bronchoscopy is a common self-limited event which does not need medical intervention.

Ackart RS, Foreman DR, Klayton RJ, Donlan CJ, Munzel TL, Schuler MA. Fiberoptic bronchoscopy in outpatient facilities, 1982. Arch Intern Med 1983;143(1):30-1.

Credle WF Jr, Smiddy JF, Elliott RC. Complications of fiberoptic bronchoscopy. Am Rev Respir Dis 1974;109(1):67-72.

Suratt PM, Smiddy JF, Gruber B. Deaths and complications associated with fiberoptic bronchoscopy. Chestm1976;69(6):747-51.

Pereira W Jr, Kovnat DM, Snider GL. A prospective cooperative study of complications following flexible fiberoptic bronchoscopy. Chest 1978;73(6):813-6.

Dajani AS, Taubert KA, Wilson W, Bolger AF, Bayer A, Ferrieri P, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. JAMA 1997;277(22):1794-801.

Gillis S, Dann EJ, Berkman N, Koganox Y, Kramer MR. Fatal Haemophilus influenzae septicemia following bronchoscopy in a splenectomized patient. Chest 1993;104(5):1607-9.

Timms RM, Harrell JH. Bacteremia related to fiberoptic bronchoscopy. A case report. Am Rev Respir Dis 1975;111(4):555-7.

Robbins H, Goldman AL. Failure of a "prophylactic" antimicrobial drug to prevent sepsis after fiberoptic bronchoscopy. Am Rev Respir Dis 1977;116(2):325-6.

Alexander WJ, Baker GL, Hunker FD. Bacteremia and meningitis following fiberoptic bronchoscopy. Arch Intern Med 1979;139(5):580-3.

Pedro-Botet ML, Ruiz J, Sabria M, Roig J, Abad J, Carrasco I, et al. Bacteremia after fibrobronchoscopy. Prospective study. Enferm Infecc Microbiol Clin 1991;9(3):159-61.

Kane RC, Cohen MH, Fossieck BE Jr, Tvardzik AV. Absence of bacteremia after fiberoptic bronchoscopy. Am Rev Respir Dis 1975;111(1):102-4.

Baum GL, Wolinsky E, editors. Textbook of Pulmonary Diseases. 5th ed. Boston: Little & Brown; 1994.

Pereira W, Kovnat DM, Khan MA, Iacovino JR, Spivack ML, Snider GL. Fever and pneumonia after flexible fiberoptic bronchoscopy. Am Rev Respir Dis 1975;112(1):59-64.

Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association. Circulation 2007;116(15):e376-7.

Beyt BE Jr, King DK, Glew RH. Fatal pneumonitis and septicemia after fiberoptic bronchoscopy. Chest 1977;72(1):105-7.

Yigla M, Oren I, Bentur L, Solomonov A, Elias N, Altshuler R, et al. Incidence of bacteraemia following fibreoptic bronchoscopy. Eur Respir J 1999;14(4):789-91.

Smith RP, Sahetya GK, Baltch AL, O'Hern J, Gort D. Bacteremia associated with fiberoptic bronchoscopy. N Y State J Med 1983;83(8-10):1045-7.

Vasanthakumar V, Bhan GL, Perera BS, Taft P. A study to assess the efficacy of chemoprophylaxis in the prevention of endoscopy-related bacteraemia in patients aged 60 and over. Q J Med 1990;75(278):647-53.

Haynes J, Greenstone MA. Fibreoptic bronchoscopy and the use of antibiotic prophylaxis. Br Med J (Clin Res Ed)1987;294(6581):1199.

Burns DM, Shure D, Francoz R, Kalafer M, Harrell J, Witztum K, et al. The physiologic consequences of saline lobar lavage in healthy human adults. Am Rev Respir Dis 1983;127(6):695-701.

Pingleton SK, Harrison GF, Stechschulte DJ, Wesselius LJ, Kerby GR, Ruth WE. Effect of location, pH, and temperature of instillate in bronchoalveolar lavage in normal volunteers. Am Rev Respir Dis 1983;128(6):1035-7.

Strumpf IJ, Feld MK, Cornelius MJ, Keogh BA, Crystal RG. Safety of fiberoptic bronchoalveolar lavage in evaluation of interstitial lung disease. Chest 1981;80(3):268-71.

Files
IssueVol 48, No 6 (2010) QRcode
SectionOriginal Article(s)
Keywords
Bacteremia endocarditis fever bronchoscopy
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Sharif-Kashani B, Shahabi P, Behzadnia N, Mohammad-Taheri Z, Mansouri D, Masjedi MR, Zargari L, Salimi Negad L. Incidence of Fever and Bacteriemia Following Flexible Fiberoptic Bronchoscopy: A Prospective Study. Acta Med Iran. 1;48(6):385-388.