Effectiveness of Oral Prophylactic Antibiotics for Diagnostic Bronchoscopy: A Nationwide Database Study.

Abstract

Rationale: Although the guidelines generally omit routine antibiotic prophylaxis for diagnostic bronchoscopy, this recommendation is primarily based on studies with relatively small sample sizes conducted at single institutions. Moreover, the applicability of recent technical and procedural advancements to these guidelines remains uncertain.

Objectives: To evaluate whether oral prophylactic antibiotic administration for diagnostic bronchoscopy reduces post-bronchoscopy infections among non-infectious diseases in the current setting.

Methods: Using the Diagnosis Procedure Combination database, a national inpatient database in Japan, we identified patients who underwent diagnostic bronchoscopy with or without oral prophylactic antibiotics between April, 2020 and March, 2022. We employed the propensity score-stabilized inverse probability of treatment weighting and instrumental variable analyses to compare post-bronchoscopy infections between the groups. Stratified analyses were also conducted based on patient profiles and antibiotic types.

Results: A total of 68,660 eligible patients were divided into prophylaxis (N=10,426) and no prophylaxis (N=58,234) groups. Post-bronchoscopy infections were observed in 612 patients (0.89%). The stabilized inverse probability of treatment weighting analysis showed that the prophylactic group was significantly associated with a decrease in post-bronchoscopy infections (odds ratio, 0.60; 95% confidence interval, 0.45 to 0.80). The instrumental variable analysis showed similar results (odds ratio, 0.50; 95% confidence interval, 0.34-0.74). Oral antibiotic prophylaxis was associated with reduction in post-bronchoscopy infection in patients who were older than 70 years, underwent bronchoscopy for malignancy, underwent biopsy or bronchoalveolar lavage, or received aminopenicillin or fluoroquinolone for prophylaxis.

Conclusions: Our findings suggest a potential role for prophylactic antibiotics in reducing post-bronchoscopy infections among non-infectious cases. While prophylactic antibiotics may help prevent these infections, their use should be carefully considered in relation to individual patient profiles and the specific antibiotics being administered.