Risk Factors of Post Endoscopic Retrograde Cholangiopancreatography Bacteremia
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background/Aims: Bacteremia following endoscopic retrograde cholangiopancreatography (ERCP) is a severe complication,but the risk factors for this condition have not yet been clearly determined. Thus, the aim of this study was to investigate the risk factors of post-ERCP bacteremia. Methods:Among patients who underwent ERCP from June 2006to May 2009, we selected patients without any signs of infection prior to the ERCP procedures. Of these patients, we further selected those who experienced bacteremia after ERCP as well as two-fold age and sex-matched controls who did not experience bacteremia after ERCP procedures. We compared clinical, laboratory and technical aspects between these two groups. Results: There were 70 patients (3.1%) who developed bacteremia after ERCP. In the multivariate analysis, a history of previous liver transplantation, an elevated serum alkaline phosphatase level and an endoscopic retrograde biliary drainage procedure were independent risk factors of post-ERCP bacteremia (p=0.006, p=0.001, and p=0.004, respectively). The microbiologic analysis revealed the presence of gram-negative organisms in 80% of the cases, and 11 patients had infections with bacteria expressing extended spectrum β-lactamases. Pseudomonas infection was significantly more common in patients who received liver transplantation as compared to patients without transplantation (p=0.014). Conclusions: A history of liver transplantation, elevated serum alkaline phosphatase levels and endoscopic retrograde biliary drainage procedure were independent risk factors of post-ERCP bacteremia and require additional attention in future studies
Abstract
Background/Aims: Bacteremia following endoscopic retrograde cholangiopancreatography (ERCP) is a severe complication,but the risk factors for this condition have not yet been clearly determined. Thus, the aim of this study was to investigate the risk factors of post-ERCP bacteremia. Methods:Among patients who underwent ERCP from June 2006to May 2009, we selected patients without any signs of infection prior to the ERCP procedures. Of these patients, we further selected those who experienced bacteremia after ERCP as well as two-fold age and sex-matched controls who did not experience bacteremia after ERCP procedures. We compared clinical, laboratory and technical aspects between these two groups. Results: There were 70 patients (3.1%) who developed bacteremia after ERCP. In the multivariate analysis, a history of previous liver transplantation, an elevated serum alkaline phosphatase level and an endoscopic retrograde biliary drainage procedure were independent risk factors of post-ERCP bacteremia (p=0.006, p=0.001, and p=0.004, respectively). The microbiologic analysis revealed the presence of gram-negative organisms in 80% of the cases, and 11 patients had infections with bacteria expressing extended spectrum β-lactamases. Pseudomonas infection was significantly more common in patients who received liver transplantation as compared to patients without transplantation (p=0.014). Conclusions: A history of liver transplantation, elevated serum alkaline phosphatase levels and endoscopic retrograde biliary drainage procedure were independent risk factors of post-ERCP bacteremia and require additional attention in future studies
참고문헌 (24)
- Bilbao MK, "Complications of endoscopic retrograde cholangiopancreatography (ERCP). A study of 10,000 cases", Gastroenterology, 70, pp.314~320 (1976)
- Freeman ML, "Complications of endoscopic biliary sphincterotomy", N Engl J Med, 335, pp.909~918 (1996)
- Deviere J, "Septicemia after endoscopic retrograde cholangiopancreatography", Endoscopy, 22, pp.72~75 (1990)
- Loperfido S, "Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study", Gastrointest Endosc, 48, pp.1~10 (1998)
- Masci E, "Complications of diagnostic and therapeutic ERCP: a prospective multicenter study", Am J Gastroenterol, 96, pp.417~423 (2001)
- Kullman E, "Bacteremia following diagnostic and therapeutic ERCP", Gastrointest Endosc, 38, pp.444~449 (1992)
- Lam SK, "How often does bacteraemia occur following endoscopic retrograde cholangiopancreatography (ERCP)?", Endoscopy, 9, pp.231~234 (1977)
- Leung JW, "Antibiotics, biliary sepsis, and bile duct stones", Gastrointest Endosc, 40, pp.716~721 (1994)
- Anderson DJ, "Infectious complications following endoscopic retrograde cholangiopancreatography: an automated surveillance system for detecting postprocedure bacteremia", Am J Infect Control, 36, pp.592~594 (2008)
- Ramirez FC, "Addition of gentamicin to endoscopic retrograde cholangiopancreatography (ERCP) contrast medium towards reducing the frequency of septic complications of ERCP", J Dig Dis, 11, pp.237~243 (2010)
- James EC, "Sepsis complications in endoscopic retrograde cholangiopancreatography", Am Surg, 42, pp.229~232 (1976)
- Motte S, "Risk factors for septicemia following endoscopic biliary stenting", Gastroenterology, 101, pp.1374~1381 (1991)
- Hirschfield GM, "Adult liver transplantation: what non-specialists need to know", BMJ, 338, pp.b1670~ (2009)
- Abt P, "Liver transplantation from controlled non-heart-beating donors: an increased incidence of biliary complications", Transplantation, 75, pp.1659~1663 (2003)
- Sanna C, "Endoscopic retrograde cholangiopancreatography in patients with biliary complications after orthotopic liver transplantation: outcomes and complications", Transplant Proc, 41, pp.1319~1321 (2009)
- Greif F, "The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation", Ann Surg, 219, pp.40~45 (1994)
- Thuluvath PJ, "Biliary complications after liver transplantation: the role of endoscopy", Endoscopy, 37, pp.857~863 (2005)
- Calne RY, "Immunosuppression in liver transplantation", N Engl J Med, 331, pp.1154~1155 (1994)
- Yabu JM, "Kidney transplantation: the ideal immunosuppression regimen", Adv Chronic Kidney Dis, 16, pp.226~233 (2009)
- Hashimoto M, "Pseudomonas aeruginosa infection after living-donor liver transplantation in adults", Transpl Infect Dis, 11, pp.11~19 (2009)
- Iida T, "Posttransplant bacteremia in adult living donor liver transplant recipients", Liver Transpl, 16, pp.1379~1385 (2010)
- Sung JY, "Defense system in the biliary tract against bacterial infection", Dig Dis Sci, 37, pp.689~696 (1992)
- Melzer M, "Biliary tract infection and bacteraemia: presentation, structural abnormalities, causative organisms and clinical outcomes", Postgrad Med J, 83, pp.773~776 (2007)
- Englesbe MJ, "Resistant pathogens in biliary obstruction: importance of cultures to guide antibiotic therapy", HPB (Oxford), 7, pp.144~148 (2005)