Infectious disease complications of Gl endoscopy: Part I, endogenous infections

doi:10.1067/mge.2003.139

Gastrointestinal Endoscopy

Volume 57, Issue 4, April 2003, Pages 546-556

https://doi.org/10.1067/mge.2003.139 Get rights and content

Summary

There is a wide variation in the rate of bacteremia after various endoscopic procedures. In general, most procedures are associated with a low frequency of bacteremia that is usually transient and does not cause clinical symptoms. Actual infectious complications are uncommon for most procedures. Recognition of infectious sequelae of endoscopic procedures can aid clinical management of these complications.

References (206)

CobeHM
Transitory bacteremia
Oral Surg
(1954)
GuntherothWG
How important are dental procedures as cause of infective endocarditis?
Am J Cardiol
(1984)
LiebermannTR
Bacteremia and fiberoptic endoscopy
Gastrointest Endosc
(1976)
MeyerGW
Prophylaxis of infective endocarditis during gastrointestinal procedures: report of a survey
Gastrointest Endosc
(1979)
RumfeldW et al.
Bacterial endocarditis after endoscopy [letter]
Lancet
(1980)
PritchardTM et al.
Prosthetic valve endocarditis due to Cardiobacterium hominis occuring after gastrointestinal endoscopy
Am J Med
(1991)
MontaltoM et al.
Mitral valve endocarditis caused by Streptococcus oralis occurring after upper gastrointestinal endoscopy
Am J Gastroenterol
(2002)
Al-ZamilF et al.
Meningococcaemia: a life-threatening complication of upper gastrointestinal endoscopy
J Infect
(1994)
CohenLB et al.
Bacteremia after endoscopic injection sclerosis
Gastrointest Endosc
(1983)
BraykoC et al.
Bacteremia during esophageal variceal sclerotherapy: its cause and prevention
Gastrointest Endosc
(1985)

SnadyH et al.

The relationship of bacteremia to the length of the injection needle in endoscopic variceal sclerotherapy

Gastrointest Endosc

(1985)

HoH et al.

A prospective controlled study of the risk of bacteremia in emergency sclerotherapy of esophageal varices

Gastroenterology

(1991)

RolandoN et al.

Infectious sequelae after endoscopic sclerotherapy of oesophageal varices: role of antibiotic prophylaxis

J Hepatol

(1993)

LoGH et al.

A comparison of the incidence of transient bacteremia and infectious sequelae after sclerotherapy and rubber band ligation of bleeding esophageal varices

Gastrointest Endosc

(1994)

LoGH et al.

A prospective, randomized trial of sclerotherapy versus ligation

Hepatology

(1995)

SelbyWS et al.

Bactermia and bacterascites after endoscopic sclerotherapy for bleeding esophageal varices and prevention by intravenous cefotaxime: a randomized trial

Gastrointest Endosc

(1994)

LaiKH et al.

Spontaneous bacterial peritonitis after endoscopic variceal sclerotherapy [letter]

Gastrointest Endosc

(1986)

BarnettJ et al.

Bacterial peritonitis following endoscopic variceal sclerotherapy

Gastrointest Endosc

(1987)

HouMC et al.

Comparison of endoscopic variceal injection sclerotherapy and ligation for the treatment of esophageal variceal hemorrhage: a prospectives, randomized trial

Hepatology

(1995)

CohenFL et al.

Solitary brain abscess following endoscopic injection sclerosis of esophageal varices

Gastrointest Endosc

(1985)

BarthelJS et al.

Fatal Candida esophageal abscess and sepsis complicating endoscopic variceal sclerosis

Gastrointest Endosc

(1987)

ChenWC et al.

Bacteremia after endoscopic injection of N-butyl-2-cyanoacrylate for gastric variceal bleeding

Gastrointest Endosc

(2001)

TsengCC et al.

Bacteremia after endoscopic band ligation of esophageal varices

Gastrointest Endosc

(1992)

LinOS et al.

Bacterial peritonitis after elective endoscopic variceal ligation: a prospective study

Am J Gastroenterol

(2000)

Al TraifI et al.

Randomized trial of ligation versus combined ligation and sclerotherapy for bleeding esophageal varices

Gastrointest Endosc

(1999)

NagamineN et al.

Occurrence of pyogenic meningitis during the

Gastrointest Endosc

(1999)

RainesDR et al.

The occurrence of bacteremia after esophageal dilation

Gastrointest Endosc

(1975)

NelsonDB et al.

Bacteremia with esophageal dilation

Gastrointest Endosc

(1998)

ZuccaroG et al.

Viridans streptococcal bacteremia after esophageal stricture dilation

Gastrointest Endosc

(1998)

HirotaWK et al.

The effect of oral decontamination with clindamycin palmitate on the prospective incidence of bacteremia after esophageal dilation: a prospective trial

Gastrointest Endosc

(1999)

NivY et al.

Bacterial endocarditis after Hurst bougienage in a patient with a benign esophageal stricture and mitral valve prolapse

Gastrointest Endosc

(1985)

BreuerGS et al.

Infective endocarditis associated with upper endoscopy: case report and review

J Infect

(1998)

ColesEF et al.

Bacterial meningitis occurring after esophageal dilation in an otherwise healthy patient

Gastrointest Endosc

(1992)

WolfD et al.

Incidence of bacteremia with elective upper gastrointestinal endoscopic laser therapy

Gastrointest Endosc

(1985)

ScottNA et al.

Pyogenic arthritis of the knee following Nd: YAG laser destruction of an esophageal cancer

Gastrointest Endosc

(1990)

LeeTH et al.

Low frequency of bacteremia after endoscopic mucosal resection

Gastrointest Endosc

(2000)

BuchmanE et al.

Bacteremia following sigmoidoscopy

Am Heart J

(1960)

WardRL

Endocarditis complicating ulcerative colitis [letter]

Gastroenterology

(1977)

LlachJ et al.

Prospective assessment of the risk of bacteremia in cirrhotic patients undergoing lower gastrointestinal endoscopy

Gastrointest Endosc

(1999)

RafothRI et al.

Bacteremia following colonoscopy

Gastrointest Endosc

(1975)

CranerGE et al.

More data on abacteremia in colonoscopy [letter]

Gastrointest Endosc

(1975)

GeraciK et al.

Does bacteremia follow colonoscopy? [letter]

Gastroenterology

(1976)

NorfleetRG et al.

Does bacteremia follow colonoscopy?

Gastroenterology

(1976)

NorfleetRG et al.

Does bacteremia follow colonoscopy? II. Results with blood cultures obtained 5, 10, and 15 minutes after colonoscopy

Gastrointest Endosc

(1976)

PelicanG et al.

Bacteremia during colonoscopy

Gastrointest Endosc

(1976)

DurackDT

Prevention of infective endocarditis

N Engl J Med

(1995)

DajaniA et al.

Prevention of bacterial endocarditis: recommendations by the American Heart Association

JAMA

(1997)

LinnemannC et al.

Blood cultures following endoscopy of the esophagus and stomach

South Med J

(1971)

Shull JrHJ et al.

Bacteremia with upper gastrointestinal endoscopy

Ann Intern Med

(1975)

MellowMH et al.

Endoscopy-related bacteremia

Arch Intern Med

(1976)

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Infectious complications of non-surgical biliary tract manipulation in paediatric patients. Role of antibiotic prophylaxis
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Despite the shorter length of antibiotic prophylaxis after June 2017, there were no significant differences in the incidence of infectious complications between the 2 time periods (p = 0.46), including bacteraemia (p = 0.87). Most of the complications from June 2017 onwards were organ/space PSI – cholangitis–, which theoretically, is not preventable despite periprocedural antibiotic prophylaxis, according to the recent literature.11,13,18,20 Finally, 72% of NSMBT-related infections in our series were early complications, and late complications predominantly occurred in procedures with prolonged antibiotic use, either for prophylaxis or therapy.
Infections related to non-surgical manipulation of the biliary tract (NSMBT) are common events despite periprocedural antibiotic prophylaxis (PAP). Since June 2017, our local protocol has indicated a 24-h regimen of intravenous piperacillin–tazobactam for this purpose.
We aimed to describe the incidence and characteristics of NSMBT-related paediatric infections, define risk factors for their development, and analyse adherence to our PAP protocol.
Epidemiological, clinical, and microbiological data were collected in consecutive NSMBT procedures performed in paediatric patients (<18 years) in our centre (2010–2019).
113 procedures in 37 patients, median age 4 years (IQR 1–8), were included. Main underlying diseases were biliary atresia (32%) and cancer (14%). Sixty-eight percent had undergone liver transplant and 70% hepaticojejunostomy. In 44 procedures (39%), the intervention was performed during the course of infection and previously prescribed antibiotic treatment was maintained. In the other 69, PAP was specifically indicated for NSMBT; antibiotic adequacy increased from 35% to 100% after June 2017. In total, 32 NSMBT-related infections (28%) occurred, mainly in the first 24 h post-procedure (72%); no deaths happened. Causative pathogens were Gram-negative rods (64%), Gram-positive cocci (28%), and Candida spp. (8%). Main related risk factors were hepaticojejunostomy, biliary obstruction, and liver transplant.
NSMBT in children entails a significant infection risk, even under antibiotic prophylaxis, being hepaticojejunostomy the main risk factor. Infectious complications mainly occurred immediately after the procedure. After establishing a PAP protocol, 100% of interventions received appropriate prophylaxis, decreasing antibiotic exposure time and potentially, the length of hospital stay.
Las infecciones relacionadas con la manipulación no quirúrgica de las vías biliares (MNQVB) son acontecimientos frecuentes, a pesar de la profilaxis antibiótica periprocedimiento (PAP). Desde junio de 2017, nuestro protocolo local indica una pauta de 24 h de piperacilina/tazobactam por vía intravenosa para este fin.
El objetivo era describir la incidencia y las características de las infecciones pediátricas relacionadas con la MNQVB, definir los factores de riesgo para su desarrollo y analizar el cumplimiento de nuestro protocolo de PAP.
Se recogieron datos epidemiológicos, clínicos y microbiológicos en procedimientos consecutivos de MNQVB realizados en pacientes pediátricos (< 18 años) en nuestro centro (2010-2019).
Se incluyeron 113 procedimientos en 37 pacientes, con una mediana de edad de 4 años (RIC 1-8). Las principales enfermedades subyacentes fueron atresia biliar (32%) y cáncer (14%). El 68% se había sometido a un trasplante de hígado y el 70% a una hepaticoyeyunostomía. En 44 procedimientos (39%), la intervención se realizó durante el transcurso de la infección y se mantuvo el tratamiento antibiótico recetado previamente. En los otros 69, la PAP estaba indicada específicamente para la MNQVB; la eficacia de los antibióticos aumentó del 35 al 100% después de junio de 2017. En total, se produjeron 32 infecciones relacionadas con la MNQVB (28%), principalmente en las primeras 24 h posteriores al procedimiento (72%); no se produjo ninguna muerte. Los patógenos causantes fueron bacilos gramnegativos (64%), cocos grampositivos (28%) y Candida spp. (8%). Los principales factores de riesgo relacionados fueron la hepaticoyeyunostomía, la obstrucción biliar y el trasplante de hígado.
La MNQVB en niños conlleva un importante riesgo de infección, incluso con profilaxis antibiótica, y la hepaticoyeyunostomía es el principal factor de riesgo. Las complicaciones infecciosas se produjeron sobre todo inmediatamente después del procedimiento. Después de establecer un protocolo de PAP, el 100% de las intervenciones recibieron la profilaxis adecuada, disminuyendo el tiempo de exposición a los antibióticos y, potencialmente, la duración de la estancia hospitalaria.
Adverse events associated with EGD and EGD-related techniques
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The rate of bacteremia after EGD was 1 in 1500, whereas rates of GI and genitourinary infections were both less than 1 in 2000.22 Endocarditis after EGD was also noted to occur at a rate of 1 in 140,000 patients in this study,22 with rare cases having previously been reported.23 Prior hospitalization, prior endoscopy (compared with noninvasive screening mammography or prostate cancer screening), and lower facility procedural volumes each independently predicted higher rates of infection.22
Effectiveness and Harms of Colorectal Cancer Screening Strategies
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Both perforation and bleeding risk are higher for diagnostic colonoscopies following abnormal stool tests or sigmoidoscopies. Transient bacteremia occurs in 4% of colonoscopy and 0.5% of sigmoidoscopy, although clinical infection is rarely reported.39 Computed tomography colonography (CTC) requires patients to undergo a full bowel preparation, after which a rectal balloon catheter is used to insufflate the colon, the CT is performed, and 2- and 3-dimensional reconstructions are used to identify colonic lesions.
Single-dose versus short-course prophylactic antibiotics for peroral endoscopic myotomy: a randomized controlled trial
2021, Gastrointestinal Endoscopy
Peroral endoscopic myotomy (POEM) has been recommended for achalasia treatment. To prevent the potential of infective risk, antibiotic prophylaxis is usually administered, whereas the additional need of antibiotic therapy after POEM is uncertain. The primary endpoint was to determine whether prophylaxis versus prophylaxis plus short therapy was needed after POEM.
Consecutive patients scheduled for POEM were randomly assigned (1:1) to group A (prophylactic cefazolin 2 g IV) or group B (prophylaxis + cefazolin 2 g IV × 3 followed by oral amoxicillin/clavulanate 3 g/day). Infective risk was assessed by means of host response, namely body temperature and serum levels of white blood cells and C-reactive protein; immune response (the cytokines interleukin [IL]-6, IL-1β, and tumor necrosis factor-α and microbial translocation mediators lipopolysaccharide binding protein and soluble CD14); and blood cultures at time points before (t0) and after (t1, t2) POEM.
After POEM, none of the 124 enrolled patients (54.6 ± 12.6 years old; 64 men) developed any fever (body temperature: t0, 36.56± .49°C; t1, 36.53± .52°C; t2, 36.48± .41°C), without any differences between groups at any time point. Regarding systemic inflammation, no difference was reported between groups in serum levels of C-reactive protein and white blood cells. Considering microbial translocation mediated response, lipopolysaccharide binding protein (group A: t0, 1539 ± 168.6 pg/mL; t1, 1321 ± 149.1 pg/mL; t2, 2492 ± 283.2 pg/mL; group B: t0, 1318 ± 115.9 pg/mL; t1, 1492 ± 163.8 pg/mL; t2, 2600 ± 328.2 pg/mL) and soluble CD14 (group A: t0, 2.16 ± .15 μg/mL; t1, 1.89 ± .15 μg/mL; t2, 2.2 ± .15 μg/mL; group B: t0, 2.1 ± .13 μg/mL; t1, 2 ± .13 μg/mL; t2, 2.5 ± .2 μg/mL) were similar between the 2 groups; the immune response cytokines IL-6, IL-1β, and tumor necrosis factor-α also were similar in the 2 groups. In relation to blood cultures, at t1 the group B bacteremia rate was 3.2% (2/62) and group A was 1.6% (1/62) with no difference (P = .6). All subsequent blood cultures were negative at t2.
According to our study, postprophylactic short-term antimicrobial therapy after POEM is not required because of a very low residual infective risk. (Clinical trial registration number: NCT03587337.)
The Endoscopy Patient as a Vector and Victim
2020, Gastrointestinal Endoscopy Clinics of North America
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This section focuses on established as well as emerging procedures with a high risk of infectious adverse events. The mean rate of bacteremia following routine ERCP is 6.4%.67 In an obstructed system, this increases to 18%,67 and current ASGE guidelines recommend prophylactic antibiotics only in patients in whom incomplete biliary drainage is expected.13
Safety of endoscopy in cancer patients with thrombocytopenia and neutropenia
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Cancer patients are prone to thrombocytopenia and neutropenia, which increase the risk of bleeding and infection. We assessed the safety of endoscopic procedures in cancer patients with thrombocytopenia and/or neutropenia.
We studied consecutive cancer patients with thrombocytopenia and/or neutropenia who underwent endoscopic procedures from 2010 through 2015. Neutropenia was defined as an absolute neutrophil count (ANC) <1000 cells/μL, and thrombocytopenia as a platelet count <100 × 10³/μL. Univariate and multivariate generalized estimating equation models were used to assess factors associated with risk of adverse events (AEs) or death.
We identified 588 patients who underwent 783 procedures; 608 procedures were performed in the setting of thrombocytopenia and 675 procedures in the setting of neutropenia. Concurrent neutropenia and thrombocytopenia were recorded in 500 endoscopies. Twenty-four patients (4.1%) experienced infectious AEs, whereas 29 (4.9%) experienced bleeding AEs within 1 week of the procedure. On multivariate analysis, platelet count ≤50 × 10³/μL was associated with risk of bleeding AEs. In contrast, poor performance status was associated with increased risk of infection AEs (P < .01). No association was observed between low ANC and infectious AEs. Poor performance status (P < .01) and platelet count ≤100 × 10³/μL (P < .05) were associated with increased risk of 30-day mortality. A persistent platelet count <20 × 10³/μL after the procedure, with a baseline platelet count of ≤20 × 10³/μL before the procedure, was associated with significant risk of bleeding AEs compared with a platelet count >20 × 10³/μL after the procedure (P < .01); furthermore, if the platelet count increased to >50 × 10³/μL after the procedure, the bleeding risk after the procedure was greatly reduced (P < .01).
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Infectious disease complications of Gl endoscopy: Part I, endogenous infections

Summary

Oral Surg

Am J Cardiol

Gastrointest Endosc

Gastrointest Endosc

Lancet

Am J Med

Am J Gastroenterol

J Infect

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastroenterology

J Hepatol

Gastrointest Endosc

Hepatology

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Hepatology

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Am J Gastroenterol

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

J Infect

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Am Heart J

Gastroenterology

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastroenterology

Gastroenterology

Gastrointest Endosc

Gastrointest Endosc

Prevention of infective endocarditis

N Engl J Med

Prevention of bacterial endocarditis: recommendations by the American Heart Association

JAMA

Blood cultures following endoscopy of the esophagus and stomach

South Med J

Bacteremia with upper gastrointestinal endoscopy

Ann Intern Med

Endoscopy-related bacteremia

Arch Intern Med