Comparison of Bronchial Lavage Cultures Taken During Endobronchial Ultrasonography in Patients with Malignant and Non-malignant Lung Diseases

Abstract

Aim Airway pathogens have become an increasingly important concern in patients with lung diseases owing to the widespread use of immunosuppressive therapies. However, limited data are available regarding airway pathogens and antibiotic resistance in bronchial lavage (BL) cultures obtained during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Materials and Methods This single-center, retrospective, cross-sectional study included 347 consecutive patients who underwent microbiological analysis of BL specimens obtained during EBUS-TBNA for the evaluation of suspected malignant or non-malignant lung disease. Clinical and microbiological characteristics were analyzed. Results The culture positivity rate of BL specimens obtained during EBUS-TBNA was significantly higher in patients with malignant lung disease than in those with non-malignant lung disease (19.2% vs. 5.4%). Among patients with malignant disease, culture positivity was significantly higher in smokers than in non-smokers (25.9% vs. 13.9%, respectively). In patients with non-malignant disease, culture positivity was 0%, 12.5%, and 15.9% in those with lymphadenopathy (LAP), a pulmonary mass/nodule, and both a mass/nodule and LAP on chest computed tomography (CT), respectively (p=0.01, p=0.192, and p=0.01). In patients with malignant disease, the corresponding culture positivity rates were 12.5%, 46.2%, and 18.6%, respectively (p=0.22, p=0.01, and p=0.738). The proportion of isolates resistant to at least one antibiotic was significantly higher in patients with malignant disease than in those with non-malignant disease (80% vs. 20%, p=0.01), whereas resistance to at least two antibiotics was observed only in patients with malignant disease (56% vs. 0%). Conclusions These findings may help clinicians identify patients in whom microbiological examination of BL samples obtained during EBUS-TBNA should be considered.

Keywords

• airway pathogens
• bronchial lavage
• endobronchial ultrasound -guided transbronchial needle aspiration (EBUS-TBNA)
• lung diseases
• microbiological examination

Supporting Institution

None

Project Number

2024/393

Ethical Statement

The study was approved by the Gaziantep University Clinical Studies Ethics Committee.

Kanser ve Kanser Dışı Akciğer Hastalıkları Olan Hastalarda Endobronşiyal Ultrasonografi Sırasında Alınan Bronşiyal Lavaj Kültürlerinin Karşılaştırılması

Abstract

Amaç İmmünsüpresif tedavilerin yaygınlaşmasıyla birlikte, hava yolu patojenleri akciğer hastalıklarında giderek daha önemli bir klinik sorun haline gelmiştir. Bununla birlikte, endobronşiyal ultrasonografi eşliğinde transbronşiyal iğne aspirasyonu (EBUS-TBNA) sırasında alınan bronşiyal lavaj (BL) örneklerinden elde edilen kültürlerde hava yolu patojenleri ve antibiyotik direnci hakkında sınırlı sayıda çalışma bulunmaktadır. Bu çalışmada, malign ve malign olmayan akciğer hastalıklarında EBUS-TBNA sırasında alınan BL kültürlerinin mikrobiyolojik özelliklerinin değerlendirilmesi amaçlandı. Gereç ve Yöntem Bu tek merkezli, retrospektif, kesitsel çalışmaya, malign veya malign olmayan akciğer hastalığı ön tanısıyla EBUS-TBNA sırasında alınan BL örneklerinin mikrobiyolojik incelemesi yapılan ardışık 347 hasta dahil edildi. Hastaların klinik ve mikrobiyolojik özellikleri değerlendirildi. Bulgular EBUS-TBNA sırasında alınan BL örneklerinde kültür pozitifliği, malign akciğer hastalığı bulunan hastalarda malign olmayan akciğer hastalığı bulunan hastalara göre anlamlı derecede daha yüksekti (%19,2'ye karşı %5,4). Malign hastalığı olan olgularda kültür pozitifliği sigara içenlerde içmeyenlere göre anlamlı olarak daha yüksekti (sırasıyla %25,9 ve %13,9). Malign olmayan hastalarda toraks bilgisayarlı tomografisinde (BT) yalnızca lenfadenopati (LAP), kitle/nodül ve kitle/nodül ile birlikte LAP saptanan olgularda kültür pozitifliği sırasıyla %0, %12,5 ve %15,9 olarak bulundu (sırasıyla p=0,01, p=0,192 ve p=0,01). Malign hastalarda ise aynı gruplarda kültür pozitifliği sırasıyla %12,5, %46,2 ve %18,6 olarak saptandı (sırasıyla p=0,22, p=0,01 ve p=0,738). En az bir antibiyotiğe dirençli mikroorganizma saptanma oranı malign hastalarda malign olmayan hastalara göre anlamlı olarak daha yüksekti (%80'e karşı %20; p=0,01). En az iki antibiyotiğe direnç ise yalnızca malign hastalarda gözlendi (%56'ya karşı %0). Sonuç Bu bulgular, klinisyenlerin EBUS-TBNA sırasında elde edilen BL örneklerinin mikrobiyolojik incelemesinin düşünülmesi gereken hastaları belirlemelerine yardımcı olabilir.

Keywords

• hava yolu patojenleri
• bronşial lavaj
• endobronşial ultrasonografi eşliğinde iğne aspirasyonu (EBUS-TBNA), akciğer hastalıkları
• mikrobiyolojik inceleme

Supporting Institution

Yok

Project Number

2024/393

Ethical Statement

The study was approved by the Gaziantep University Clinical Studies Ethics Committee.

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