Supplementary Material for: Infections Related to Airway Stenting: A Systematic Review

Background: Airway stenting is nowadays an established method for the palliative and/or curative treatment of central airways obstruction. However, complications related to the use of airway stents have been reported. Objective: We endeavored to systematically evaluate the currently available evidence regarding the infections associated with airway stenting. Methods: We independently searched in PubMed for relevant reports. We considered articles which reported on clinical infections related to airway stenting. A case was identified as stent-associated respiratory tract infection (SARTI) according to the authors of the individual papers, based on clinical findings with or without radiological or microbiological confirmation. Results: Twenty-three articles (19 cohorts/case series and 4 case reports), involving 501 patients with airway stents, were included. The indication for airway stenting was malignancy and benign disease in 45 and 55% of the included patients, respectively. Ninety-three (19%) out of the 501 stented patients experienced SARTI. Pneumonia was the most common type of SARTI (47%), followed by bronchial infection (24%), cavitary pneumonia/lung abscess and intraluminal fungus ball. Staphylococcus aureus (39%) and Pseudomonas aeruginosa (28%) were the most commonly identified pathogens. Twenty-six (68%) out of the 38 patients with SARTI, for whom outcome data were available, died. Conclusion: The accumulated and evaluated evidence suggests that SARTI probably involves 1 in 5 patients with airway stent. Although the possibility of SARTI should not discourage the interventional pneumologists from inserting airway stents, the data seem to underline the urgent need for establishing a consensus definition and diagnostic criteria for SARTI.

背景：气道支架置入术如今已成为中央气道梗阻姑息性乃至根治性治疗的成熟手段。然而，现有研究已报道气道支架应用相关的各类并发症。
目的：本研究旨在系统评估现有关于气道支架置入术后相关感染的全部证据。
方法：研究团队独立在PubMed数据库中检索相关文献，纳入所有报道气道支架置入术后临床感染的研究。本研究依据各原始文献作者的定义，将经临床体征（伴或不伴影像学或微生物学验证）确诊的病例归类为支架相关呼吸道感染（stent-associated respiratory tract infection, SARTI）。
结果：最终共纳入23篇文献（含19项队列/病例系列研究及4篇病例报告），涉及501例接受气道支架置入术的患者。纳入患者中，气道支架置入的指征分别为恶性病变（45%）与良性病变（55%）。501例支架置入患者中，共93例（19%）发生SARTI。肺炎为最常见的SARTI类型（47%），其次为支气管感染（24%），此外还包括空洞性肺炎/肺脓肿及腔内真菌球。检出的常见病原菌为金黄色葡萄球菌（Staphylococcus aureus, 39%）与铜绿假单胞菌（Pseudomonas aeruginosa, 28%）。在获得转归数据的38例SARTI患者中，26例（68%）死亡。
结论：经汇总与评估的现有证据表明，每5例气道支架置入患者中即有1例可能发生SARTI。尽管SARTI的发生风险不应阻碍介入肺科医师开展气道支架置入操作，但本研究数据亦凸显了尽快制定SARTI统一定义与诊断标准的迫切需求。