Failure of a "prophylactic" antimicrobial drug to prevent sepsis after fiberoptic bronchoscopy

A 53-year-old patient with lymphoblastic lymphoma developed progressive interstitial pulmonary infiltrates. The patient was believed to have Pseudomonas bronchitis and was given parenteral gentamicin. Transbronchial lung biopsy performed through a fiberoptic bronchoscope was complicated by the development of Pseudomonas septicemia. The organism isolated on blood culture, like the one isolated on sputum culture, was fully susceptible to gentamicin in vitro. A prophylactic antimicrobial drug did not prevent bacteremic Pseudomonas infection in our immunosuppressed patient with pre-existent Pseudomonas bronchitis.