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.

Keywords:
Airway stent, Interventional pulmonary medicine, Infection, Complications
1.
Harkins WB: An endotracheal metallic prosthesis in the treatment of stenosis of the upper trachea. Ann Otol Rhinol Laryngol 1952;61:663–676.
2.
Ernst A, Feller-Kopman D, Becker HD, Mehta AC: Central airway obstruction. Am J Respir Crit Care Med 2004;169:1278–1297.
3.
Makris D, Marquette CH: Tracheobronchial stenting and central airway replacement. Curr Opin Pulm Med 2007;13:278–283.
4.
Breitenbucher A, Chhajed PN, Brutsche MH, Mordasini C, Schilter D, Tamm M: Long-term follow-up and survival after Ultraflex stent insertion in the management of complex malignant airway stenoses. Respiration 2008;75:443–449.
5.
Bolliger CT, Mathur PN, Beamis JF, Becker HD, Cavaliere S, Colt H, Diaz-Jimenez JP, Dumon JF, Edell E, Kovitz KL, Macha HN, Mehta AC, Marel M, Noppen M, Strausz J, Sutedja TG: ERS/ATS statement on interventional pulmonology. European Respiratory Society/American Thoracic Society. Eur Respir J 2002;19:356–373.
6.
Saito Y, Imamura H: Airway stenting. Surg Today 2005;35:265–270.
7.
Noppen M, Pierard D, Meysman M, Claes I, Vincken W: Bacterial colonization of central airways after stenting. Am J Respir Crit Care Med 1999;160:672–677.
8.
Park KY, Park CH: Candida infection in a stent inserted for tracheal stenosis after heart lung transplantation. Ann Thorac Surg 2005;79:1054–1056.
9.
Sha J, Yan Z, Zheng L: Pneumonia in a heart-lung recipient after airway stent placement. Thorac Cardiovasc Surg 2007;55:332–334.
10.
Abbas O, Fares M, Jamaleddine G, Arayssi T, Touma Z, Khalil PB: Endobronchial stenting for respiratory complications in relapsing polychondritis. Clin Rheumatol 2007;26:271–273.
11.
Noppen M, Van Renterghem D, Vanderstraeten P: The wrong stent at the wrong time: a cautionary tale. Respiration 2003;70:313–316.
12.
Anderson MB, Kriett JM, Harrell J, Smith C, Kapelanski DP, Tarazi RY, Perricone A, Jamieson SW: Techniques for bronchial anastomosis. J Heart Lung Transplant 1995;14:1090–1094.
13.
Geller KA, Wells WJ, Koempel JA, St John MA: Use of the Palmaz stent in the treatment of severe tracheomalacia. Ann Otol Rhinol Laryngol 2004;113:641–647.
14.
Shin JH, Hong SJ, Song HY, Park SJ, Ko GY, Lee SY, Kim HB, Jang JY: Placement of covered retrievable expandable metallic stents for pediatric tracheobronchial obstruction. J Vasc Interv Radiol 2006;17:309–317.
15.
Spatenka J, Khaghani A, Irving JD, Theodoropoulos S, Slavik Z, Yacoub MH: Gianturco self-expanding metallic stents in treatment of tracheobronchial stenosis after single lung and heart and lung transplantation. Eur J Cardiothorac Surg 1991;5:648–652.
16.
Sasano S, Onuki T, Adachi T, Oyama K, Ikeda T, Kanzaki M, Kuwata H, Sakuraba M, Matsumoto T, Nitta S: Nitinol stent for the treatment of tracheobronchial stenosis. Jpn J Thorac Cardiovasc Surg 2001;49:311–316.
17.
George PJ, Irving JD, Khaghani A, Dick R: Role of the Gianturco expandable metal stent in the management of tracheobronchial obstruction. Cardiovasc Intervent Radiol 1992;15:375–381.
18.
Mondain M, Crampette L, Makeieff M, Barazer M, Guerrier B: Calibration of laryngotracheal stenoses using a Montgomery tube: indications and results. Rev Laryngol Otol Rhinol (Bord) 1993;114:373–377.
19.
Higgins R, McNeil K, Dennis C, Parry A, Large S, Nashef SA, Wells FC, Flower C, Wallwork J: Airway stenoses after lung transplantation: management with expanding metal stents. J Heart Lung Transplant 1994;13:774–778.
20.
Wassermann K, Eckel HE, Michel O, Muller RP: Emergency stenting of malignant obstruction of the upper airways: long-term follow-up with two types of silicone prostheses. J Thorac Cardiovasc Surg 1996;112:859–866.
21.
Dasgupta A, Dolmatch BL, Abi-Saleh WJ, Mathur PN, Mehta AC: Self-expandable metallic airway stent insertion employing flexible bronchoscopy: preliminary results. Chest 1998;114:106–109.
22.
Belleguic C, Lena H, Briens E, Desrues B, Bretagne JF, Delaval P, Kernec J: Tracheobronchial stenting in patients with esophageal cancer involving the central airways. Endoscopy 1999;31:232–236.
23.
Herrera JM, McNeil KD, Higgins RS, Coulden RA, Flower CD, Nashef SA, Wallwork J: Airway complications after lung transplantation: treatment and long-term outcome. Ann Thorac Surg 2001;71:989–994.
24.
Madden BP, Datta S, Charokopos N: Experience with Ultraflex expandable metallic stents in the management of endobronchial pathology. Ann Thorac Surg 2002;73:938–944.
25.
Saad CP, Ghamande SA, Minai OA, Murthy S, Pettersson G, DeCamp M, Mehta AC: The role of self-expandable metallic stents for the treatment of airway complications after lung transplantation. Transplantation 2003;75:1532–1538.
26.
Saad CP, Murthy S, Krizmanich G, Mehta AC: Self-expandable metallic airway stents and flexible bronchoscopy: long-term outcomes analysis. Chest 2003;124:1993–1999.
27.
Lin SM, Lin TY, Chou CL, Chen HC, Liu CY, Wang CH, Lin HC, Yu CT, Lee KY, Kuo HP: Metallic stent and flexible bronchoscopy without fluoroscopy for acute respiratory failure. Eur Respir J 2008;31:1019–1023.
28.
Shin JH, Kim SW, Shim TS, Jung GS, Kim TH, Ko GY, Song HY: Malignant tracheobronchial strictures: palliation with covered retrievable expandable nitinol stent. J Vasc Interv Radiol 2003;14:1525–1534.
29.
Ernst A, Majid A, Feller-Kopman D, Guerrero J, Boiselle P, Loring SH, O’Donnell C, Decamp M, Herth FJ, Gangadharan S, Ashiku S: Airway stabilization with silicone stents for treating adult tracheobronchomalacia: a prospective observational study. Chest 2007;132:609–616.
30.
Terra RM, Minamoto H, Tedde ML, de Almeida JL, Jatene FB: Self-expanding stent made of polyester mesh with silicon coating (Polyflex) in the treatment of inoperable tracheal stenoses. J Bras Pneumol 2007;33:241–247.
31.
Lund ME, Force S: Airway stenting for patients with benign airway disease and the Food and Drug Administration advisory: a call for restraint. Chest 2007;132:1107–1108.
32.
Burns KE, Orons PD, Dauber JH, Grgurich WF, Stitt LW, Raghu S, Iacono AT: Endobronchial metallic stent placement for airway complications after lung transplantation: longitudinal results. Ann Thorac Surg 2002;74:1934–1941.
33.
Arcavi I, Benowitz NL: Cigarette smoking and infection. Arch Intern Med 2004;164:2206–2216.
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2009
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