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

<i>Background:</i> 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. <i>Objective:</i> We endeavored to systematically evaluate the currently available evidence regarding the infections associated with airway stenting. <i>Methods:</i> 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. <i>Results:</i> 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. <i>Staphylococcus aureus</i> (39%) and <i>Pseudomonas aeruginosa</i> (28%) were the most commonly identified pathogens. Twenty-six (68%) out of the 38 patients with SARTI, for whom outcome data were available, died. <i>Conclusion:</i> 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.

<i>背景：</i>气道支架置入术目前已成为中央气道梗阻姑息性及/或根治性治疗的成熟手段。然而，临床已有关于气道支架使用相关并发症的报道。<i>目的：</i>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研究证据。<i>方法：</i>本研究独立在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相关临床感染的研究。依据各原始研究作者的判定标准，结合临床体征，辅以或不辅以影像学或微生物学验证，将符合条件的病例定义为支架相关呼吸道感染（stent-associated respiratory tract infection, SARTI）。<i>结果：</i>本研究共纳入23篇文献（19项队列/病例系列研究及4篇病例报告），涉及501例气道支架置入患者。纳入患者中，气道支架置入的适应证分别为恶性疾病（45%）与良性疾病（55%）。501例支架置入患者中，共93例（19%）发生支架相关呼吸道感染。肺炎是最常见的支架相关呼吸道感染类型（47%），其次为支气管感染（24%），以及空洞性肺炎/肺脓肿与腔内真菌球。最常检出的病原体为*金黄色葡萄球菌（Staphylococcus aureus）*（39%）与*铜绿假单胞菌（Pseudomonas aeruginosa）*（28%）。在获得临床转归数据的38例支架相关呼吸道感染患者中，26例（68%）死亡。<i>结论：</i>现有汇总评估的研究证据表明，每5例气道支架置入患者中即有1例可能发生支架相关呼吸道感染。尽管该感染的发生风险不应阻碍介入肺科医师开展气道支架置入术，但本研究数据凸显了尽快制定该感染统一定义与诊断标准的迫切需求。