Vardhman Mahavir Medical College & Safdarjung Hospital

Clinical guidelines recommend endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) as the initial diagnostic tool for lung cancer staging. However, despite the availability of mediastinal forceps biopsy and cryobiopsy, the optimal diagnostic approaches for other mediastinal conditions remain unclear.

We searched multiple databases and sources up to February 21, 2025, and employed single-arm, pairwise, and network meta-analytical approaches to comprehensively evaluate EBUS-based biopsies for mediastinal diseases in terms of efficacy and safety.

Fifteen prospective studies including 1,316 participants evaluated five EBUS-based mediastinal biopsy strategies (EBUS-TBNA, forceps biopsy, cryobiopsy, and the combinations of EBUS-TBNA with forceps biopsy or cryobiopsy) were involved. Concomitant EBUS-TBNA enhanced the efficacy of both forceps biopsy and cryobiopsy. EBUS-TBNA plus cryobiopsy yielded the best diagnostic outcome, showing significant benefits over EBUS-TBNA (OR 4.01, 95% CrI 3.05-5.33), forceps biopsy (OR 2.75, 95% CrI 1.94-3.92), cryobiopsy (OR 1.80, 95% CrI 1.33-2.45), and EBUS-TBNA plus forceps biopsy (OR 1.81, 95% CrI 1.20-2.72). A similarly favourable safety profile was observed in all EBUS-based biopsy methods.

EBUS-TBNA is the diagnostic cornerstone for mediastinal lesions, with EBUS-TBNA plus cryobiopsy being most effective. All EBUS-guided biopsies demonstrated a favourable safety profile.

The emergence of multidrug-resistant (MDR) strains, including those producing metallo-β-lactamases (MBL), necessitates the development of effective therapeutic strategies. The combination of ceftazidime-avibactam (CZA) and aztreonam (ATM) has shown promise as a potential treatment option. This study aimed to evaluate practical and accessible antimicrobial susceptibility testing (AST) methods for assessing the synergy of CZA and ATM in carbapenemase-producing Enterobacterales species, particularly in resource-limited settings with high patient volumes.

This cross-sectional study was conducted at a tertiary care hospital in Central India from October 2023 to July 2024. It compared different synergy testing methods to the gold-standard broth microdilution (BMD) method in genotypically confirmed carbapenemase-producing isolates. The study evaluated various synergy methods, such as the E-strip, disk replacement, inverse D-zone, and disk approximation.

Of the 60 Enterobacterales isolates, most carried the bla_NDM gene (88.33%, 53/60). Using the BMD method, 73.33% (44/60) of the isolates showed synergy between CZA and ATM. The E-strip method was found to have almost perfect agreement (κ = 1) with BMD, making it highly reliable. However, it may be impractical for high-volume laboratories due to cost and complexity. On the other hand, the disk replacement and inverse D-zone methods demonstrated high sensitivity and specificity, with perfect (κ = 0.874) and substantial (κ = 0.803) agreement with BMD, respectively, providing more practical and cost-effective alternatives. However, the disk approximation method showed lower sensitivity and moderate agreement with BMD (κ = 0.510), making it less reliable.

The combination of CZA and ATM demonstrated significant synergistic results in MBL and serine carbapenemase-producing Enterobacterales species. The disk replacement and inverse D-zone methods are feasible and cost-effective for CZA and ATM synergy testing in routine AST within resource-limited settings, guiding treatment decisions.

Early and accurate diagnosis of pyogenic infections is essential to guide treatment and prevent complications like bacteremia, endocarditis, and death. Debate and controversy continue regarding the optimal specimen for microbiological diagnosis of pyogenic infections in emergency settings. Therefore, this study was conducted to evaluate concordance in the microbial yields obtained from the three techniques of sampling, i.e., pus swab, pus aspirate, and tissue biopsy.

A total of 363 paired samples (swab and aspirate, swab and biopsy, aspirate and biopsy) from the same patient and site of infection received over one year were analyzed, retrospectively. Microbial yields, mixed bacterial growth, and contamination rates were compared among the three sample types.

Tissue biopsies consistently provided the highest microbiological yield, outperforming both swabs (54.2% vs. 34.6%) and aspirates (43.8% vs. 38.5%). This difference in the diagnostic yield for paired tissue biopsy and swab samples was statistically significant (p value = 0.0038). Swabs exhibited high false negative rates (23.4%). The highest concordance was observed between tissue biopsy and aspirate (73.9%), indicating better reliability of these samples over swabs, which are superficial in nature.

Tissue biopsies demonstrate the highest diagnostic yield for pyogenic infections, reinforcing their role as the gold standard. Pus aspirates offer a reliable alternative for less invasive sampling, while swabs are limited by their high false negative rates and inability to differentiate between colonizers and pathogens. In conclusion, employing appropriate sampling techniques based on the infection site can significantly enhance diagnostic precision and optimize patient care in emergency settings.