Motte S, Deviere J, Dumonceau J M, Serruys E, Thys J P, Cremer M
Department of Medecine, Hôpital Erasme, Université Libre de Bruxelles, Belgium.
Gastroenterology. 1991 Nov;101(5):1374-81. doi: 10.1016/0016-5085(91)90091-x.
The purpose of this study was to identify patients who were more likely to experience septicemia after endoscopic biliary drainage. In an attempt to determine the relative importance of each risk factor and their possible interdependancy to more precisely identify high-risk patients and to deduce some guidelines for prevention, a discriminant regression analysis of risk factors for septicemia was used. Clinical, biological, and radiological data of 34 consecutive patients who experienced septicemia within 3 days after endoscopic biliary stenting were reviewed retrospectively and compared with data of a group of 71 patients without any septic complication. If only data available before the procedure were used in the discriminant analysis, prior cholangitis and leucocytosis appeared as significant risk factors, but the linear combination of these data could not predict septicemia in 50% of cases. When information concerning the quality of drainage after the procedure was introduced into the analysis, 91% of the septicemic patients were identified, and other expected risk factors such as the nature of the stricture, the type of drainage, or prior cholangitis and leukocytosis had no or marginal predictive values. Patients referred from centers where duodenoscopes might have been poorly disinfected appeared to be at higher risk for Pseudomonas aeruginosa septicemia. These results emphasize the crucial role of the quality of drainage as a risk for septicemia. Regarding the prevention of infection, it is concluded from this study that (a) pure diagnostic endoscopic retrograde cholangiopancreatography should be avoided in obstructed patients if drainage cannot be performed during the same procedure; (b) drainage should be as complete as possible; (c) antibiotics should be administered before ERCP to every patient with suspected obstructive jaundice and should cover P. aeruginosa if local epidemiological data suggest that there is a problem with disinfection of the endoscopes; and (d) the quality of drainage should guide the duration of antibiotic prophylaxis.
本研究的目的是确定在内镜下胆道引流术后更易发生败血症的患者。为了确定每个风险因素的相对重要性及其可能的相互依存关系，以便更精确地识别高危患者并推导一些预防指南，我们对败血症的风险因素进行了判别回归分析。回顾性分析了34例在内镜下胆道支架置入术后3天内发生败血症的连续患者的临床、生物学和放射学数据，并与71例无任何败血症并发症患者的数据进行了比较。如果在判别分析中仅使用手术前可用的数据，先前的胆管炎和白细胞增多症是显著的风险因素，但这些数据的线性组合在50%的病例中无法预测败血症。当将术后引流质量的信息纳入分析时，91%的败血症患者被识别出来，而其他预期的风险因素，如狭窄的性质、引流类型、先前的胆管炎和白细胞增多症，没有或只有边际预测价值。从十二指肠镜消毒可能不佳的中心转诊来的患者似乎发生铜绿假单胞菌败血症的风险更高。这些结果强调了引流质量作为败血症风险的关键作用。关于感染的预防，本研究得出以下结论：(a)如果在同一手术过程中无法进行引流，应避免对梗阻患者进行单纯诊断性内镜逆行胰胆管造影术；(b)引流应尽可能彻底；(c)应在ERCP前对每例疑似梗阻性黄疸患者使用抗生素，如果当地流行病学数据表明内镜消毒存在问题，应覆盖铜绿假单胞菌；(d)引流质量应指导抗生素预防的持续时间。
