CHEST Guidelines-Infections-After-Radial-EBUS-Guided-Transbronchial

Infections-After-Radial-EBUS-Guided-Transbronchial

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The article addresses the incidence and implications of infections following radial endobronchial ultrasound (EBUS)-guided transbronchial lung biopsy (TBLB), a procedure that has emerged as a safer alternative to CT-guided lung biopsies for diagnosing peripheral pulmonary lesions. Despite the technical advances in bronchoscopy, which have minimized some complications compared to CT-guided biopsies, the exact rate and risk factors for infections specific to these procedures have been less documented.<br /><br />A recent study by Souma et al., highlighted in this editorial, retrospectively analyzed 1,045 patients undergoing radial EBUS-guided TBLB, revealing an infection rate of 4.47%. Specific infections included pneumonia (2.3%), intratumoral infection, lung abscesses, pleuritis, and empyema, which led to treatment delays or could not proceed with therapy in some cases, resulting in patient mortality in three instances. Key risk factors identified were lesion cavitation, low-density areas within lesions, and airway stenosis. Interestingly, the study indicated no significant prevention of infections by prophylactic antibiotics, raising questions about the pathophysiology of post-bronchoscopy infections.<br /><br />The study's retrospective nature and single-center design present inherent limitations, including potential biases. The invasive procedure, typically performed with mouth scope insertion, carries a risk of transferring oral flora, thus causing infections, despite techniques such as using a guide sheath which aim to mitigate this.<br /><br />Overall, the editorial underlines the necessity of comprehensive documentation of bronchoscopy-related complications, including infections. It calls for future prospective studies to validate infection risk factors and explore the utility of prophylactic antibiotics, particularly in cases involving necrotic and cavitary lesions. Such data are essential for enhancing informed consent processes and shared decision-making in clinical practice.

Keywords

radial EBUS

transbronchial lung biopsy

infections

bronchoscopy

pulmonary lesions

prophylactic antibiotics

infection risk factors

pneumonia

lung abscesses

Souma study