LAUSR

BACKGROUND Infectious complications after endobronchial ultrasound-guided transbronchial biopsy with a guide sheath (EBUS-GS-TBB) are serious in that they may delay or change scheduled subsequent therapy. The aim of this study was to identify risk factors for infection after EBUS-GS-TBB. METHODS We retrospectively reviewed the medical records of 1,045 consecutive patients who had undergone EBUS-GS-TBB for peripheral lung lesions between January 2013 and December 2017 at Fujita Health University Hospital. We evaluated the following risk factors for infectious complications after EBUS-GS-TBB: relevant patient characteristics (age, comorbidities), lesion size, CT features of target lesion (intratumoral low-density areas [LDAs], cavitation), stenosis of responsible bronchus observed by bronchoscopy, and laboratory data before EBUS-GS-TBB (white blood cell count and C-reactive protein concentration). RESULTS Forty-seven of the studied patients developed infectious complications (24 pneumonia, 14 intratumoral infection, 3 lung abscess, 3 pleuritis, 3 empyema), among whom the complication caused a delay in cancer treatment in 13 patients, cancellation of cancer treatment in 7, and death in 3. Multivariate analysis showed that cavitation (P=.007), intratumoral LDAs (P<.001), and stenosis of responsible bronchus observed by bronchoscopy (P<.001) were significantly associated with infectious complications after EBUS-GS-TBB. Prophylactic antibiotics had been administered to 13 patients in the infection group. Propensity matched analysis could not show significant benefit of prophylactic antibiotics in preventing post-EBUS-GS-TBB infections. CONCLUSIONS Cavitation, LDAs for CT features of target lesions, and stenosis of responsible bronchus observed by bronchoscopy are risk factors of post-EBUS-GS-TBB infection. In our cohort, prophylactic antibiotics failed to prevent infectious complications.