Prospective Risk Assessment of Bacteremia in Patients Undergoing Endoscopic Ultrasound Guided Fine Needle Aspiration (EUS FNA) of Rectal and Perirectal Lesions

Abstract

Background: There are no data regarding the risk of bacteremia following endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) of rectal and perirectal lesions. Our aim was to prospectively evaluate the frequency of bacteremia and associated complications following EUS FNA of rectal and perirectal lesions. Methods: Patients referred for EUS FNA from the lower GI tract were candidates for this IRB approved protocol. 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. A first set of blood cultures (aerobic and anaerobic, 20-30 cc/each) were obtained immediately prior to the procedure (Set #1), a second set was obtained following routine flexible sigmoidoscopy/radial EUS, and a third set 15 minutes following EUS FNA. Patients were monitored in the immediate post-procedure period and by phone follow-up one week after the procedure for the development of complications. Results: 42 subjects were enrolled of whom 27 underwent EUS FNA (17 male, 10 female) with a mean age of 61 years (range 40-93). A total of 117 FNA's (mean 4.3/patient) were performed at 29 sites (mean 1.1 sites/patient) (Table 1). In addition, a total of 74 biopsies of mucosal lesions were performed (mean 2.7/patient). Cultures grew organisms in 2 patients (7.4%; 95%CI:3-17%). Coagulase negative Staphylococcus grew in patient (3rd of 3 blood cultures), and Moraxella grew in another patient (2nd of 3 blood cultures). These were interpreted as contaminates. Therefore, of the 81 blood cultures, two (2.5%, 95%CI:1-6%) blood cultures were contaminates. None of the 27 patients developed true positive blood cultures and none developed immediate or delayed infectious complications. Conclusion: These preliminary data suggest that bacteremia is uncommon after EUS FNA of rectal and perirectal GI lesions. EUS FNA of rectal and perirectal solid lesions is likely a low risk procedure for infectious complications and may not warrant antibiotic prophylaxis for spontaneous bacterial endocarditis in patients without specific indications for prophylaxis.