Prospective Study of Bacteremia and Complications With EUS FNA of Rectal and Perirectal Lesions

Michael J. Levy, Ian D. Norton, Jonathan E. Clain, Felicity T Enders, Ferga Gleeson, Paul John Limburg, Heidi Nelson, Elizabeth Rajan, Mark Topazian, Kenneth Ke Ning Wang, Maurits J. Wiersema, Walter R. Wilson

Research output: Contribution to journalArticle

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Abstract

Background & Aims: 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.

Original languageEnglish (US)
Pages (from-to)684-689
Number of pages6
JournalClinical Gastroenterology and Hepatology
Volume5
Issue number6
DOIs
StatePublished - Jun 2007

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Fine Needle Biopsy
Bacteremia
Prospective Studies
Lower Gastrointestinal Tract
Anti-Bacterial Agents
Gemella
Moraxella
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Confidence Intervals
Peptostreptococcus
Sigmoidoscopy
Bacterial Endocarditis
Bacteroides fragilis
Upper Gastrointestinal Tract
Gastrointestinal Endoscopy
Coagulase
Endocarditis
Staphylococcus
Signs and Symptoms
Guidelines

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Prospective Study of Bacteremia and Complications With EUS FNA of Rectal and Perirectal Lesions. / Levy, Michael J.; Norton, Ian D.; Clain, Jonathan E.; Enders, Felicity T; Gleeson, Ferga; Limburg, Paul John; Nelson, Heidi; Rajan, Elizabeth; Topazian, Mark; Wang, Kenneth Ke Ning; Wiersema, Maurits J.; Wilson, Walter R.

In: Clinical Gastroenterology and Hepatology, Vol. 5, No. 6, 06.2007, p. 684-689.

Research output: Contribution to journalArticle

Levy, Michael J. ; Norton, Ian D. ; Clain, Jonathan E. ; Enders, Felicity T ; Gleeson, Ferga ; Limburg, Paul John ; Nelson, Heidi ; Rajan, Elizabeth ; Topazian, Mark ; Wang, Kenneth Ke Ning ; Wiersema, Maurits J. ; Wilson, Walter R. / Prospective Study of Bacteremia and Complications With EUS FNA of Rectal and Perirectal Lesions. In: Clinical Gastroenterology and Hepatology. 2007 ; Vol. 5, No. 6. pp. 684-689.
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AU - Levy, Michael J.

AU - Norton, Ian D.

AU - Clain, Jonathan E.

AU - Enders, Felicity T

AU - Gleeson, Ferga

AU - Limburg, Paul John

AU - Nelson, Heidi

AU - Rajan, Elizabeth

AU - Topazian, Mark

AU - Wang, Kenneth Ke Ning

AU - Wiersema, Maurits J.

AU - Wilson, Walter R.

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N2 - Background & Aims: 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.

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