Etiological profile and prognostic factors of airway fistula: a retrospective study

Airway fistula, such as tracheoesophageal fistula (TOF) and bronchopleural fistula (BPF), is a rare but life-threatening complication associated with cancer treatment. However, the etiological profile and its association with prognosis of airway fistulas remain unclear. The current study aimed to identify the etiological profile and prognostic factors of airway fistula.

A total of 102 patients with TOF or BPF, recruited between January 2021 and December 2023, were analyzed. Patients' demographics, clinical presentations, and microbiological data were collected, while survival outcomes and prognostic factors were analyzed.

In total, 67 pathogen species and 223 strains were identified, with P. aeruginosa and S. aureus among the most common. Multidrug-resistant bacteria (MDRB) constituted 61% of identified pathogens, with a higher prevalence in BPF cases. Patients with a chronic course of fistula (P=0.04) and those with Staphylococcus infections (P=0.03) had a high risk of carrying MDRB. Though TOF and BPF patients' clinical outcomes did not significantly differ in the Fine-Gray model, MDRB infections (P<0.001) and Pseudomonas infections (P=0.02) were associated with prolonged fistula stabilization period. Cox regression identified multidrug resistance (MDR) infections (P=0.04) and Pseudomonas infections (P=0.02) as key factors associated with prolonged fistula stabilization period.

MDRB and infection of Pseudomonas were closely associated with poor prognosis of airway fistula.