PURPOSE: 1] To compare the incidence of infections for different airway stents. 2] To measure clinical consequences of these infections.
METHODS: Patients who underwent airway stent placement for malignant central airway obstruction in the last 5 years were reviewed. Standard definitions were used for lobar, multilobar and post-obstructive pneumonias and bronchitis. Time to first infection for various stent types were compared using a Cox model.
RESULTS: Of these, 58 (25%) were in the trachea, 55 (24%) were in the right main stem extending into the bronchus intermedius, 27 (11%) were in the bronchus intermedius, 62 (26%) were in the left main bronchus and 33 (14%) were at the carina (Y stents). Of the 226 stents analyzed, 137 (58%) were Ultraflex, 36 (15%) were Alveolus and 53 (23%) were silicone stents. Incidence rate was 0.0055 pulmonary infections /patient stent day. 22 (28%) were lobar pneumonias, 14 (17.5%) were multilobar pneumonias, 16 (20%) were post-obstructive pneumonias and 28 (35%) were episodes of bronchitis. 38 (47%) episodes resulted in hospital admission with 10 (12.5%) stent removals. The risk of pulmonary infections was higher with Alveolus stents as compared to Ultraflex stents (HR 1.98, 95% CI 1.03-3.81, p=0.04). We failed to demonstrate a difference in incidence rates of pulmonary infections between silicone and Ultraflex stents. (HR 1.16, 95% CI 0.67-2.02, p=0.59).
CONCLUSIONS: In patients with malignant central airway obstruction, airway stenting is associated with a high infection rate. Alveolus stents were associated with a higher incidence of infection.
CLINICAL IMPLICATIONS: Prospective studies are required to understand the differences in pulmonary infections between different airway stents. The role of prophylactic antibiotics in these patients needs to be investigated.
DISCLOSURE: The following authors have nothing to disclose: Archan Shah, Pushan Jani, George Eapen, Carlos Jimenez, Mona Sarkiss, Rodolfo Morice, David Ost
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