Sharara Ala I, El Hajj Ihab I, Mroueh Mohammad, Kyriacos Soula Boustany, Abdul-Baki Heitham, Chaar Hani F, Aoun Elie, Hashash Jana G, Mansour Nabil M, Kanj Souha S
Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
South Med J. 2011 Mar;104(3):189-94. doi: 10.1097/SMJ.0b013e318205de10.
Cholangitis and biliary sepsis are rare but serious complications of endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study is to investigate the safety, efficacy, and biliary penetration of ertapenem, a newer carbapenem with a long half-life and broad-spectrum antimicrobial activity, for ERCP prophylaxis.
Patients with obstructive jaundice without cholangitis received a single dose of ertapenem equal to 1 gram intravenously prior to ERCP. A 2-3 mL bile sample was collected after cannulation and prior to contrast injection. Patients were observed for 72 hours for cholangitis or drug-related adverse events. Biliary ertapenem levels were measured using high-performance liquid chromatography (HPLC).
Twenty-eight patients (ages 18-87 years, M/F ratio 1:1) were enrolled. Seven had no cholestasis and were included to study ertapenem penetration in unobstructed biliary trees. Cannulation was achieved in all patients. One patient (3.6%) with persistent intrahepatic stones developed cholangitis. No drug-related adverse events were noted. The mean time from ertapenem administration to bile collection was 60 ± 24 minutes. There was a significant negative correlation between serum bilirubin and biliary ertapenem levels (r = -0.542, P = 0.003) with the highest level (6.25 μg/mL) noted in unobstructed biliary systems.
Ertapenem appears to be a safe and effective prophylaxis in patients with obstructive jaundice undergoing ERCP despite a limited biliary penetration in patients with high-grade obstruction.
胆管炎和胆源性败血症是内镜逆行胰胆管造影术（ERCP）罕见但严重的并发症。本研究的目的是调查厄他培南（一种半衰期长且具有广谱抗菌活性的新型碳青霉烯类药物）用于ERCP预防的安全性、有效性和胆汁穿透性。
无胆管炎的梗阻性黄疸患者在ERCP术前静脉注射单剂量1克厄他培南。插管后且在注入造影剂前采集2 - 3毫升胆汁样本。观察患者72小时，以了解是否发生胆管炎或药物相关不良事件。使用高效液相色谱法（HPLC）测量胆汁中厄他培南的水平。
纳入28例患者（年龄18 - 87岁，男女比例1:1）。7例无胆汁淤积，纳入研究以观察厄他培南在无梗阻胆管树中的穿透情况。所有患者均成功插管。1例（3.6%）患有持续性肝内结石的患者发生了胆管炎。未观察到药物相关不良事件。从给予厄他培南到采集胆汁的平均时间为60±24分钟。血清胆红素与胆汁中厄他培南水平之间存在显著负相关（r = -0.542，P = 0.003），在无梗阻胆管系统中观察到的最高水平为6.25μg/mL。
尽管在高度梗阻患者中胆汁穿透有限，但厄他培南似乎是接受ERCP的梗阻性黄疸患者安全有效的预防药物。
