Prospective study of bacteremia and complications With EUS FNA of rectal and perirectal lesions.
OBJECTIVE
Recent studies showed that endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is a low-risk procedure for causing bacteremia and infectious complications when sampling solid lesions of the upper gastrointestinal (GI) tract. As a result, antibiotics are not recommended for prophylaxis against endocarditis. Our aim was to prospectively evaluate the risk of bacteremia and other infectious complications in patients undergoing EUS FNA of lower GI tract lesions.


METHODS
Patients referred for EUS FNA of lower GI tract lesions were considered for enrollment. Patients were excluded if there was an indication for preprocedure antibiotic administration based on American Society for Gastrointestinal Endoscopy guidelines, had taken antibiotics within the prior 7 days, or if they had a cystic lesion. Blood cultures were obtained immediately before the procedure, after flexible sigmoidoscopy/radial EUS, and 15 minutes after EUS FNA.


RESULTS
One hundred patients underwent a total of 471 FNAs (mean, 4.7 FNAs/patient; range, 1-10 FNAs/patient). Blood cultures were positive in 6 patients. Cultures from 4 patients (4.0%, 95% confidence interval, 1.6%-9.8%) grew coagulase-negative Staphylococcus (n = 2), Peptostreptococcus stomatis (n = 1), or Moraxella (n = 1), which were considered contaminants. Two patients (2.0%, 95% confidence interval, 0.6%-7%) developed bacteremia: Bacteroides fragilis (n = 1) and Gemella morbillorum (n = 1). No signs or symptoms of infection developed in any patient.


CONCLUSIONS
EUS FNA of solid lesions in the lower GI tract should be considered a low-risk procedure for infectious complications that does not warrant prophylactic administration of antibiotics for the prevention of bacterial endocarditis.
Levy
Michael J
MJ
Division of Gastroenterology and Hepatology, Mayo Clinic Foundation, Rochester, Minnesota 55905, USA. levy.michael@mayo.edu
Norton
Ian D
ID
Clain
Jonathan E
JE
Enders
Felicity B
FB
Gleeson
Ferga
F
Limburg
Paul J
PJ
Nelson
Heidi
H
Rajan
Elizabeth
E
Topazian
Mark D
MD
Wang
Kenneth K
KK
Wiersema
Maurits J
MJ
Wilson
Walter R
WR
D000230:Adenocarcinoma / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D001707:Biopsy, Needle / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000473:pathology*; D015897:Comorbidity; D004697:Endocarditis, Bacterial / Q000517:prevention & control; D016145:Endoscopy, Digestive System; D019160:Endosonography; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology; D018570:Risk Assessment; D012812:Sigmoidoscopy