Minami Daisuke, Takigawa Nagio, Oki Masahide, Saka Hideo, Shibayama Takuo, Kiura Katsuyuki
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Kita-ku, Okayama city, Okayama 701-1192, Japan.
Department of General Internal Medicine 4, Kawasaki Medical School, 2-1-80 Nakasange, Okayama 700-8505, Japan.
Respir Investig. 2018 Jul;56(4):356-360. doi: 10.1016/j.resinv.2018.03.006. Epub 2018 May 10.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure with a high diagnostic yield in lesions adjacent to the airways. However, complications associated with EBUS-TBNA, such as mediastinitis, have recently been reported. Oral bacteria contamination in punctured lymph nodes can cause severe infections. In the current study, we investigated whether endobronchial intubation using EBUS-TBNA can prevent oral bacterial contamination of punctured lymph nodes.
We retrospectively evaluated 80 patients (102 lymph nodes) who had undergone EBUS-TBNA and divided them two groups: Group A comprised 60 patients who had undergone EBUS-TBNA with endobronchial intubation and Group B consisted of 20 patients who had undergone EBUS-TBNA without endobronchial intubation. The patients' medical records were examined and the two groups were compared using the unpaired Student's t-test.
EBUS-TBNA needle wash cultures were positive in only two Group A cases (3.3%), but in all 20 Group B cases (100%) (P < 0.05). Except for one case of Mycobacterium tuberculosis, all bacterial isolates yielded typical oropharyngeal commensal flora. Fever (≥ 38.0 °C) was observed in six Group A cases (10%) and two Group B cases (10%; P = 0.526). This was treated by cooling, a single administration of non-steroidal anti-inflammatory drugs, and/or antibiotic therapy. Fever was not associated with any clinical features, including malignancy in punctured lesions, number of punctures, echo features, simultaneous peripheral biopsy, additional oral prophylactic antibiotics, or positive needle wash cultures.
Endobronchial intubation may prevent contamination by oropharyngeal commensal bacteria.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）是一种微创检查方法，对气道周围病变具有较高的诊断率。然而，最近有报道称EBUS-TBNA会引发一些并发症，如纵隔炎。穿刺淋巴结时口腔细菌污染可导致严重感染。在本研究中，我们调查了使用EBUS-TBNA进行支气管内插管是否可以预防穿刺淋巴结的口腔细菌污染。
我们回顾性评估了80例接受EBUS-TBNA检查的患者（共102个淋巴结），并将他们分为两组：A组包括60例接受EBUS-TBNA并进行支气管内插管的患者，B组包括20例接受EBUS-TBNA但未进行支气管内插管的患者。检查患者的病历，并使用非配对学生t检验对两组进行比较。
A组仅2例（3.3%）的EBUS-TBNA针洗培养结果为阳性，而B组所有20例（100%）的结果均为阳性（P<0.05）。除1例结核分枝杆菌感染外，所有分离出的细菌均为典型的口咽共生菌群。A组有6例（10%）患者出现发热（≥38.0°C），B组有2例（10%）患者出现发热（P=0.526）。通过降温、单次使用非甾体类抗炎药和/或抗生素治疗。发热与任何临床特征均无关联，包括穿刺病变的恶性程度、穿刺次数、回声特征、同时进行的外周活检、额外的口服预防性抗生素或针洗培养结果阳性。
支气管内插管可能预防口咽共生菌的污染。
