Abstract

Background: The risk of bacteremia associated with endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) of rectal and perirectal lesions has never been studied. As a result, the need for antibiotics in this setting is uncertain and practices vary. Aim: Our aim was to prospectively determine the rate of bacteremia and associated complications associated with EUS FNA of rectal and perirectal lesions. Methods: Patients were considered for enrollment if referred with solid lower GI tract pathology indicating the potential need for EUS FNA. Patients were excluded if they had an indication for pre-procedure antibiotics as determined by the ASGE guidelines or had taken antibiotics, for any reason, within the prior 7 days. The first set of blood cultures (aerobic and anaerobic, 20-30cc/each) were obtained immediately prior to the procedure (Set #1), another set was obtained following routine flexible sigmoidoscopy/radial EUS (Set #2), and the last set 15 minutes following EUS FNA (Set #3). Patients were monitored in the immediate post-procedure period and followed for evidence of associated complications. Results: 151 patients were enrolled of whom 76 underwent EUS FNA (53 male, 23 female) having a mean age of 60 years (range 25-93). Eighty-one sites were sampled leading to a total of 358 FNA's (mean 4.7/patient) (Table 1). In addition, a total of 224 mucosal biopsies were obtained (mean 2.9/patient). Positive blood cultures were acquired in 4 patients (5.3%; 95% CI: 2.1-12.8%). Coagulase negative Staphylococcus grew in one patient (3rd set of blood cultures), and Moraxella grew in another patient (2nd set of blood cultures). Both were considered contaminates. Bacteroides fragilis grew in one patient (2nd set of blood cultures), and Gemella morbillorum grew in another patient (3rd set of blood cultures). Both were considered true positives. As a result, true positive blood cultures occurred in 2 patients (2.6%, 95% CI: 0.7-9.1%). None of the 79 patients (0%, 95% CI:0-1%), regardless of blood culture status, developed infectious complications. Conclusion: These data suggest that bacteremia and associated complications are uncommon after EUS FNA of solid rectal and perirectal lesions, occurring at a rate commonly associated with diagnostic colonoscopy. As a result, antibiotic prophylaxis may not be warranted for spontaneous bacterial endocarditis in patients without specific indications for prophylaxis.

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