Am. J. Respir. Crit. Care Med., Volume 160, Number 2, August 1999, 672-677

Bacterial Colonization of Central Airways after Stenting

MARC NOPPEN, DENIS PIÉRARD, MARC MEYSMAN, INGEBORG CLAES, and WALTER VINCKEN

Respiratory Division and Microbiology Department, Academic Hospital AZ-VUB, Free University of Brussels, Brussels, Belgium

Airway stenting (AS) is increasingly used in the management of obstructive lesions of the central airways. Although retention of secretions and infection have been reported as complications of AS, the microbiological consequences of AS have not yet been evaluated. In this study, we prospectively performed protected specimen brush (PSB) sampling of the airways, before and 3 to 4 wk after AS, in 14 consecutive patients (65 ± 17 yr), suffering from bronchial (), extensive esophageal (), thyroid (), and adenocystic () carcinoma, stenotic tracheal burn lesions (), postintubation stenosis (), and Wegener's granulomatosis (). A cutoff value of  10² colony-forming units (cfu) · ml¹ was considered diagnostic for airway colonization (AC). PSB results were related to the presence and degree of secretion retention (SR) at the level of the stent. In five of the 14 patients, AC was present prior to AS; in three of these, potentially pathogenic microorganisms (PPM) were identified. After AS, AC was found in 11 (including seven patients without prior AC) of the 14 patients. In six of these patients, one or more PPM were present (Pseudomonas aeruginosa [4], Staphylococcus aureus [3], Streptococcus pneumoniae [1], Klebsiella spp. [1]). Although AC tended to be associated with the presence of SR (PSB  10² cfu · ml¹ in 10 of 12 SR-positive and in zero SR-negative cases; PSB < 10² cfu · ml¹ in two SR-positive and in two SR-negative cases), statistical significance was not reached (Fisher exact test, p = 0.06). We conclude that AS is frequently followed by AC, the majority of which occurs in patients without AC prior to AS, and is caused by PPM. In no case, however, AC was associated with clinical signs of infection. AC tended to be associated with SR in the stent.

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