Prevention of sepsis following endoscopic retrograde cholangiopancreatography

doi:10.1016/0195-6701(91)90169-9

Journal of Hospital Infection

Volume 19, Supplement C, September 1991, Pages 65-70

https://doi.org/10.1016/0195-6701(91)90169-9 Get rights and content

Abstract

Oral ciprofloxacin was studied as a prophylactic antimicrobial agent in high- and low-risk patients undergoing endoscopic retrograde cholangiography. Ciprofloxacin appeared to be effective, good serum levels were attained, and the drug compared favourably on grounds of cost and convenience with a parenterally-administered cephalosporin.

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Cited by (36)

Incidence, severity, and mortality of post-ERCP pancreatitis: an updated systematic review and meta-analysis of 145 randomized controlled trials
2023, Gastrointestinal Endoscopy
The incidence, severity, and mortality of post-ERCP pancreatitis (PEP) largely remain unknown with changing trends in ERCP use, indication, and techniques. We sought to determine the incidence, severity, and mortality of PEP in consecutive and high-risk patients based on a systemic review and meta-analysis of patients in placebo and no-stent arms of randomized control trials (RCTs).
The MEDLINE, Embase, and Cochrane databases were searched from the inception of each database to June 2022 to identify full-text RCTs evaluating PEP prophylaxes. The incidence, severity, and mortality of PEP from the placebo or no-stent arms of RCTs were recorded for consecutive and high-risk patients. A random-effects meta-analysis for a proportions model was used to calculate PEP incidence, severity, and mortality.
One hundred forty-five RCTs were found with 19,038 patients in the placebo or no-stent arms. The overall cumulative incidence of PEP was 10.2% (95% confidence interval [CI], 9.3-11.3), predominantly among the academic centers conducting such RCTs. The cumulative incidences of severe PEP and mortality were .5% (95% CI, .3-.7) and .2% (95% CI, .08-.3), respectively, across 91 RCTs with 14,441 patients. The cumulative incidences of PEP and severe PEP were 14.1% (95% CI, 11.5-17.2) and .8% (95% CI, .4-1.6), respectively, with a mortality rate of .2% (95% CI, 0-.3) across 35 RCTs with 3733 patients at high risk of PEP. The overall trend for the incidence of PEP among patients randomized to placebo or no-stent arms of RCTs has remained unchanged from 1977 to 2022 (P = .48).
The overall incidence of PEP is 10.2% but is 14.1% among high-risk patients based on this systematic review of placebo or no-stent arms of 145 RCTs; this rate has not changed between 1977 and 2022. Severe PEP and mortality from PEP are relatively uncommon.
Clostridium difficile infection following systemic antibiotic administration in randomised controlled trials: a systematic review and meta-analysis
2016, International Journal of Antimicrobial Agents
Citation Excerpt :
We did not have access to the full-text article of 230 RCTs (17.3%). At least one CDI episode in at least one of the study arms was reported in 79 (5.9%) of the 1332 selected RCTs (32,042 patients, 344 CDI episodes) [11–89]. Supplementary Table S2 shows the characteristics of RCTs included in this meta-analysis.
Antibiotics have been the most important risk factor for Clostridium difficile infection (CDI). However, only data from non-randomised studies have been reviewed. We sought to evaluate the risk for development of CDI associated with the major antibiotic classes by analysing data from randomised controlled trials (RCTs). The PubMed, Cochrane and Scopus databases were searched and the references of selected RCTs were also hand-searched. Eligible studies should have compared only one antibiotic versus another administered systemically. Inclusion of studies comparing combinations of antibiotics was allowed only if the second antibiotic was the same or from the same class or if it was administered in a subset of the enrolled patients who were equally distributed in the two arms. Only a minority of the selected RCTs (79/1332; 5.9%) reported CDI episodes. Carbapenems were associated with more CDI episodes than fluoroquinolones [risk ratio (RR) = 2.44, 95% confidence interval (CI) 1.32–4.49] and cephalosporins (RR = 2.24, 95% CI 1.46–3.42), but not penicillins (RR = 2.53, 95% CI 0.87–7.41). Cephalosporins were associated with more CDIs than penicillins (RR = 2.36, 95% CI 1.32–4.23) and fluoroquinolones (RR = 2.84, 95% CI 1.60–5.06). There was no difference in CDI frequency between fluoroquinolones and penicillins (RR = 1.34, 95% CI 0.55–3.25). Finally, clindamycin was associated with more CDI episodes than cephalosporins and penicillins (RR = 3.92, 95% CI 1.15–13.43). In conclusion, data from RCTs showed that clindamycin and carbapenems were associated with more CDIs than other antibiotics.
Incidence, severity, and mortality of post-ERCP pancreatitis: A systematic review by using randomized, controlled trials
2015, Gastrointestinal Endoscopy
Data regarding the incidence and severity of post-ERCP pancreatitis (PEP) are primarily from nonrandomized studies.
To determine the incidence, severity, and mortality of PEP from a systematic review of the placebo or no-stent arms of randomized, controlled trials (RCTs).
MEDLINE, EMBASE, and Cochrane databases were searched to identify RCTs evaluating the efficacy of drugs and/or pancreatic stents to prevent PEP.
Systematic review of patients enrolled in RCTs evaluating agents for PEP prophylaxis.
Patients in the placebo or no-stent arms of the RCTs
ERCP.
Incidence, severity, and mortality of PEP.
There were 108 RCTs with 13,296 patients in the placebo or no-stent arms. Overall, the PEP incidence was 9.7% and the mortality rate was 0.7%. Severity of PEP was reported for 8857 patients: 5.7%, 2.6%, and 0.5% of cases were mild, moderate, and severe, respectively. The incidence of PEP in 2345 high-risk patients was 14.7% and the severity of PEP was mild, moderate, and severe in 8.6%, 3.9%, and 0.8%, respectively, with a 0.2% mortality rate. The incidence of PEP was 13% in North American RCTs compared with 8.4% in European and 9.9% in Asian RCTs. ERCPs conducted before and after 2000 had a PEP incidence of 7.7% and 10%, respectively.
Difference in PEP risk among patients in the included RCTs.
The incidence of PEP and severe PEP is similar in high-risk patients and the overall cohort. Discrepancies in the incidence of PEP across geographic regions require further study.
Infection after ERCP, and antibiotic prophylaxis: a sequential quality-improvement approach over 11 years
2008, Gastrointestinal Endoscopy
Infection is a known complication of ERCP procedures, and the role of antibiotic prophylaxis is uncertain.
To document the incidence of infection after ERCP while changing the policy for antibiotic prophylaxis.
Retrospective analysis of data collected prospectively on infection complications, with progressive reduction in the use of prophylactic antibiotics.
Single-center university referral hospital.
A total of 11,484 ERCP procedures were documented prospectively over a period of 11 years.
After baseline assessment, the use of prophylactic antibiotics was sequentially reduced and simplified in 3 phases.
Incidence of infection, categorized by severity.
The infection rate was low overall and decreased significantly with time, from 0.48% to 0.25%, despite a marked reduction in the proportion of patients given antibiotics (from 95% to 25%). Multivariate analysis also showed that the only category of patients at increased risk for infection (despite antibiotics) was the subgroup undergoing interventions for biliary problems after liver transplantation.
A lack of routine follow-up may mean that some delayed infectious complications were not recorded. The low risk of infection in this series may reflect the high technical success rate for relief of biliary obstruction; thus, our current minimalist antibiotic policy may not be generalizable to community practice.
Infectious complications of ERCP can be kept to a minimum with a limited use of prophylactic antibiotics.
Biliary candida infections in primary sclerosing cholangitis
2006, Journal of Hepatology
Patients with Primary Sclerosing Cholangitis (PSC) frequently develop dominant stenoses of the bile ducts and bacterial infections represent a major problem in such patients. In the present study, the role of fungal infections of the bile ducts has been evaluated.
In a prospective non-randomized trial, in 67 consecutive patients with PSC, 148 bile samples, each taken at one endoscopic examination, were microbiologically analysed.
Candida species were found in 8/67 patients whereas Aspergillus was not detected. Seven patients with biliary Candida had a dominant stenosis and one had a wide papillotomy with chronic ascending cholangitis. Altogether 7/49 of patients with dominant stenosis and 1/18 of patients without dominant stenosis had Candida in their bile. All patients with biliary Candida intermittently had received antibiotics and had advanced disease with cholestasis. Candida disappeared spontaneously in 2/7 patients, cleared after antifungal treatment in 2, and persisted in 3 patients. Patients with biliary Candida had more severe cholangitis with higher CRP and serum bilirubin compared to those without Candida infection.
This is the first report on the identification of Candida species in the bile of patients with PSC. Apart from bacterial also fungal infection of the bile ducts should be considered in the treatment of such patients.
Dental management of the (solid) organ transplant patient
2003, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics
Citation Excerpt :
An evaluation of possible infections in the biliary system by invasive procedures, especially in immunosuppressed patients, has been shown to cause the translocation of bacteria from these sites to the blood stream and become a source of sepsis.55-57 Prophylactic antibiotic therapy, especially during biliary tract manipulation in these patients, has been effective in the prevention of systemic infection.57-59 Postoperative guidelines for recipients of solid-organ transplants frequently advise medication with antibiotics before dental procedures,10,60-65 but there are no evidence-based data from controlled clinical trials to support this recommendation, nor is a consensus evident.
The need to provide dental care for organ transplant candidates and recipients will increase in conjunction with the continued expansion of the use of organ transplantation. For the transplant candidate, dental care usually requires application of practice standards that fall within the scope of management of the severely medically compromised patient. There are, however, few guidelines and no clinical trials or outcomes assessments that address appropriate care for transplant recipients. Furthermore, despite the high rate of infectious complications among patients who have received organ transplants, there is little evidence that dental disease contributes to this risk. This article reviews the current status of dental care practices that have been recommended and presents a rationale that can be applied as the basis for guidelines and recommendations for the treatment of the organ transplant patient. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:383-9)

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View full text

Prevention of sepsis following endoscopic retrograde cholangiopancreatography

Abstract

Gastroenterology

Gastrointest Endosc

J Hosp Infect

Gastrointest Endosc

J Hosp Infect

Endoscopic cannulation of the ampulla of Vater: a preliminary report

Ann Surg

Endoscopic papillotomy and removal of gallstones

Br Med J

Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial

Br J Surg

Endoscopy-related bacteraemia

Arch Intern Med