Objectives

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become a standard procedure, but little is known about its infectious complications. The aim of this study is to evaluate the incidence and risk factors of infectious complications of EBUS-TBNA and its clinical course, including effects on anti-cancer treatment.

Methods

This is a nested case-control study of patients who received EBUS-TBNA and were followed for at least 2 months at Samsung Medical Center from August 2009 to April 2019. Patients with clinical symptoms of infection and correlating chest images were defined as the infection group (n = 33). The controls were randomly selected from patients without infectious complication. Multivariate logistic regression with backward selection was used to identify the risk factors of infectious complications.

Results

Of the 6826 patients, 33 (0.48%) infectious complications were identified, comprising pneumonia (n = 20) and mediastinal infections (n = 13). Target lesions with necrotic features on chest computed tomography (CT) scan (adjusted odds ratio [aOR], 3.08; 95% confidence interval [CI], 1.49–6.40; P = 0.002) and procedures that were performed via the esophagus (aOR, 3.19; 95% CI, 1.47–6.88; P = 0.003) were independently associated with infectious complications. Among patients ultimately diagnosed with cancer, the infection group tended to refuse anti-cancer treatment compared to controls (32/459, 7.0% vs. 5/30, 16.7%; P = 0.066). However, among the patients who received anti-cancer treatment, there was no delay in onset of treatment.

Conclusions

Infectious complications of EBUS-TBNA are rare; however, attention should be paid if the target lesion appears necrotic on chest CT or if the procedure is performed via the esophagus. Although it was not conclusive due to its rarity, patients with infectious complications tended not to receive anti-cancer treatment.

中文翻译：

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EBUS-TBNA 的感染并发症：使用 10 年登记数据的巢式病例对照研究

 目标

支气管内超声引导下经支气管针吸活检（EBUS-TBNA）已成为标准手术，但对其感染并发症知之甚少。本研究的目的是评估 EBUS-TBNA 感染并发症的发生率和危险因素及其临床过程，包括对抗癌治疗的影响。

 方法

这是一项巢式病例对照研究，对象为2009年8月至2019年4月期间在三星医疗中心接受EBUS-TBNA并随访至少2个月的患者。出现感染临床症状和相关胸部影像的患者被定义为感染组（n = 33）。对照组是从没有感染性并发症的患者中随机选择的。采用后向选择的多变量逻辑回归来确定感染并发症的危险因素。

 结果

在 6826 名患者中，发现 33 例（0.48%）感染性并发症，包括肺炎（n = 20）和纵隔感染（n = 13）。胸部计算机断层扫描 (CT) 扫描中具有坏死特征的目标病灶（调整后的比值比 [aOR]，3.08；95% 置信区间 [CI]，1.49–6.40；P = 0.002）和通过食道进行的手术（aOR， 3.19；95% CI，1.47-6.88；P = 0.003）与感染并发症独立相关。在最终诊断为癌症的患者中，与对照组相比，感染组倾向于拒绝抗癌治疗（32/459, 7.0% vs. 5/30, 16.7%；P = 0.066）。然而，在接受抗癌治疗的患者中，没有出现治疗起效延迟的情况。

 结论

EBUS-TBNA 的感染并发症很少见；然而，如果胸部CT显示靶病灶坏死或通过食道进行手术，则应引起注意。尽管由于其罕见而尚无定论，但患有感染性并发症的患者往往不接受抗癌治疗。