Efficacy of Antibiotic Prophylaxis after Endobronchial Ultrasound-guided Transbronchial Needle Aspiration: A Preliminary Prospective Study

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is useful for diagnosing mediastinal and hilar lymphadenopathy. While bacteremia and serious infectious complications after EBUS-TBNA have been reported, the efficacy of antibiotic prophylaxis is unclear. This preliminary prospective study aimed to evaluate the efficacy of antibiotic prophylaxis after EBUS-TBNA. Methods: Patients were randomly assigned to the antibiotic group (n = 43) or control group (n = 47). Ampicillin/ sulbactam was intravenously administered before the puncture, followed by oral amoxicillin/clavulanate. The primary outcome was body temperature (BT) within 5 days after EBUS-TBNA. The secondary outcomes were the change in the white blood cell count (WBC) and C-reactive protein (CRP) value before and after the examination, and the frequency of infectious complications that required antibiotics. We also assessed the clinical characteristics of patients with fever. Results: BT after EBUS-TBNA did not significantly differ between the groups. Antibiotic prophylaxis had no effect on the changes in the WBC and CRP value. Neither group had infectious complications associated with EBUS-TBNA. The smoking pack-year was higher in the group with fever than without fever, although the WBC and CRP value at baseline were similar between the groups. The number of punctures, presence of low-density areas in the lymph nodes, and antibiotic treatment were unrelated to the development of fever following EBUS-TBNA. Conclusion: Results of this study and the low frequency of infectious complications, which has been demonstrated in previous reports, suggest that antibiotic prophylaxis is not recommended for EBUS-TBNA (UMIN: 000008813).