title: Use of antimicrobials for EUS-guided FNA of pancreatic cysts: a retrospective, comparative analysis.
abstract: BACKGROUND
  Pancreatic cystic lesions present a challenge for patients and physicians alike. Morphology alone is inaccurate in discriminating lesion pathology, and use of EUS-guided FNA (EUS-FNA) improves accuracy. Current American Society for Gastrointestinal Endoscopy guidelines recommend prophylactic antibiotics during FNA of cystic lesions to minimize infection risk. However, evidence pertaining to infection risk has been conflicting. The use of prophylactic antibiotics might not be free of other adverse events and might not prevent infection.
  
  
  OBJECTIVE
  To assess the impact of antimicrobial therapy for prophylaxis during EUS-FNA of pancreatic cysts.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  This study involved all patients who underwent EUS-FNA of pancreatic cysts at one institution from May 2007 to April 2010.
  
  
  METHODS
  Antibiotic prophylaxis for EUS-FNA.
  
  
  METHODS
  Infection of a pancreatic cyst, fever, or bacteremia after EUS-FNA. Secondary variables included other complications of the procedure related to the use of prophylaxis (ie, allergic reactions, secondary infections).
  
  
  RESULTS
  EUS-FNA was performed on 253 patients in 266 procedures. Antibiotics were used in 88 endoscopy cases (ATB group), whereas no antibiotics were used in 178 cases (NATB group). There were no differences in patient or cyst characteristics between groups. There were 4 major complications in the NATB group (localized bleeding, 2; pancreatitis, 1; bile leakage, 1) and 2 in the ATB group (possible cyst infection, 1; bile leakage, 1) (P = 1.0). Eight mild adverse events were observed in the NATB group and 6 in the ATB group (P = .56). Infections and antibiotic-related complications occurred in 1 (0.6%) (transient fever) in the NATB group and 4 (4.5%) in the ATB group (local allergic reaction, 2; possible cyst infection, 1; Clostridium difficile diarrhea, 1) (P = .04).
  
  
  CONCLUSIONS
  Retrospective analysis.
  
  
  CONCLUSIONS
  The incidence of infectious complications after EUS-FNA of pancreatic cystic lesions, with or without antibiotic prophylaxis, appears very low. We have not observed a protective effect from periprocedural prophylactic antibiotic administration.
authors.affiliation: Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Guarner-Argente
authors.forename: Pari
authors.initials: P
authors.lastname: Shah
authors.forename: Anna
authors.initials: A
authors.lastname: Buchner
authors.forename: Nuzhat A
authors.initials: NA
authors.lastname: Ahmad
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kochman
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Ginsberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D044963:Biopsy, Fine-Needle / Q000009:adverse effects*; D015331:Cohort Studies; D019160:Endosonography / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents