Department of Medicine, Gastroenterology Section, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas 77030, USA.
J Dig Dis. 2010 Aug;11(4):237-43. doi: 10.1111/j.1751-2980.2010.00444.x.
Bacteremia and sepsis are serious complications of endoscopic retrograde cholangiopancreatography (ERCP) and occur in between 0.5 and 3% of cases. Patients with obstructed bile ducts are at highest risk of developing septic complications. The purpose of this investigation was to determine whether the addition of gentamicin to the ERCP contrast medium prevents or reduces the growth of Pseudomonas aeruginosa in vitro.
Artificial bile ducts were fashioned out of dialysis tubing and suspended in flasks containing brain heart infusion (BHI) broth. The tubing contained BHI broth alone, with or without contrast medium or with contrast medium plus gentamicin. The artificial ducts were inoculated with gentamicin-sensitive or gentamicin-resistant P. aeruginosa and quantitative cultures were performed.
The contrast medium alone was bacteriostatic to both sensitive and resistant P. aeruginosa isolates. The addition of gentamicin to the contrast medium eliminated the sensitive strain after 2 h and resulted in a reduction in the number of gentamicin-resistant P. aeruginosa after 4 h. Incubation of the resistant isolate in the presence of contrast and gentamicin for an additional 4 h led to a further reduction in viable bacteria but did not completely eliminate the organisms.
These results support the use of gentamicin in the contrast medium injected into the biliary system as an ancillary method to prevent post-ERCP sepsis.
菌血症和败血症是内镜逆行胰胆管造影术（ERCP）的严重并发症，在 0.5%至 3%的病例中发生。胆管阻塞的患者发生感染性并发症的风险最高。本研究旨在确定 ERCP 造影剂中添加庆大霉素是否可以预防或减少体外铜绿假单胞菌的生长。
将透析管制成人工胆管，并悬挂在含有脑心浸液（BHI）肉汤的烧瓶中。管内仅含有 BHI 肉汤，或含有造影剂或造影剂加庆大霉素。将人工胆管用庆大霉素敏感或庆大霉素耐药的铜绿假单胞菌接种，并进行定量培养。
单独的造影剂对敏感和耐药的铜绿假单胞菌分离株均具有抑菌作用。向造影剂中添加庆大霉素可在 2 小时后消除敏感菌株，并在 4 小时后减少耐庆大霉素的铜绿假单胞菌数量。将耐药株在存在造影剂和庆大霉素的情况下再孵育 4 小时可进一步减少活菌数，但不能完全消除细菌。
这些结果支持在胆道系统中注射的造影剂中使用庆大霉素作为预防 ERCP 后败血症的辅助方法。
