Endoscopic Ultrasonography-Guided Fine-Needle Aspiration Of Pancreatic Cysts: Antibiotic Prophylaxis For Immunocompromised Patients?

Aims The current guidelines of the ASGE, ESGE and DGVS recommend peri-interventional antibiotic prophylaxis (AP) for endosonographic fine-needle aspiration (EUS-FNA) of pancreatic cysts (PC) to prevent infection [1] [2] [3]. Recently published studies [4] [5], critically question periprocedural AP because no statistically significant benefit of AP could be demonstrated. As part of a retrospective evaluation, we are investigating the infection rate depending on AP at our clinic at the University Medical Center Mainz. A particular focus of our analysis is the influence of immunocompromised on the infection rate.

Methods 201 patients, undergoing EUS-FNA or biopsy of the pancreas from 2020 to 2024 at our clinic, were screened retrospectively. After review of patient databases, 153 patients were excluded and only patients with EUS-FNA of PC were included. Patients with immunosuppressive therapy and diseases associated with immunosuppression such as diabetes mellitus, renal insufficiency or malignancies were analysed separately in a subgroup [6].

Results EUS-FNA of PC from 48 patients (18 women (38%), mean age of 66 years) were included in the final analysis. Of these, 25 patients (52%) were immunocompromised. 20 patients (42%) had received AP (12 peri-interventional and 8 pre-existing antibiotic therapy) and 28 patients (58%) had not received AP. The average post-interventional observation period was 30 days. No infections were detected in the group without AP, while one infection occurred in the group with AP. Statistical analysis using the Fisher exact test revealed no significant difference between the groups in terms of infection rate (two-sided p-value=1.000; one-sided p-value=0.583). No infections occurred in the patients of the immunocompromised subgroup (25 in total, 7 with AP, 18 without AP). The Fisher exact test (for complications two-sided p-value=1.000; one-sided p-value=0.693) showed no significant difference for this subgroup with regard to AP.

Conclusions The EUS-FNA of pancreatic cysts with or without AP showed no statistically significant difference of the infection rate. The subgroup analysis of immunocompromised patients also showed no difference in infection on AP. Taking into account recently published data and in view of our results, we advise against administering AP for EUS-FNA of pancreatic cysts.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Committee et al. 2015
• 2 Denzer U. et al. 2015
• 3 Polkowski et al. 2017
• 4 Hakim et al. 2022
• 5 Colán Hernández et al. 2020
• 6 Facciorusso et al. 2020