Distinct bacterial profiles according to structural lung disease in patients undergoing bronchial artery embolization...

Hemoptysis frequently prompts emergency bronchial artery embolization (BAE), and bacterial infection is a common and modifiable trigger. As structural lung disease shapes airway microbiology, pathogen profiles may differ according to the structural lung disease phenotype and could inform empiric antibiotic selection in patients undergoing BAE.

We retrospectively reviewed consecutive patients who underwent BAE for hemoptysis at a tertiary referral center between January 2021 and December 2025. Structural lung disease was stratified into three categories based on computed tomography findings: (1) absence of structural lung disease, (2) bronchiectasis, or (3) emphysema/interstitial lung disease (ILD). Respiratory specimens (sputum or bronchial washing fluid) were evaluated using standard cultures and multiplex polymerase chain reaction (mPCR), when ordered clinically.

A total of 188 patients were included [absence of structural lung disease (n = 70), bronchiectasis (n = 96), or emphysema/ILD (n = 22)]. Overall, 77 patients (41.0%) showed ositive culture or mPCR results. The most commonly identified bacteria were Streptococcus pneumoniae (14.3%) in patients without structural lung disease, Pseudomonas aeruginosa (29.2%) in patients with bronchiectasis, and Klebsiella pneumoniae subsp. pneumoniae (18.2%) in patients with emphysema/ILD. P. aeruginosa was more frequent in patients with bronchiectasis than in those without structural lung disease (29.2% vs. 1.4%, P < 0.001). K. pneumoniae was detected more frequently in 18.2% of patients with emphysema/ILD and in 5.7% of those without structural lung disease (P = 0.090).

Patients who underwent BAE showed distinct bacterial profiles according to their underlying structural lung disease. These differences may suggest that tailoring empiric antibiotics according to the structural lung disease phenotype could be considered when an infection is suspected in patients with hemoptysis.