Mizrahi Meir, Roemi Lilach, Shouval Daniel, Adar Tomer, Korem Maya, Moses Alon, Bloom Alan, Shibolet Oren
Liver Unit, Division of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
World J Hepatol. 2011 May 27;3(5):130-6. doi: 10.4254/wjh.v3.i5.130.
To identify all cases of bacteremia and suspected endotipsitis after Transjugular intrahepatic portosystemic shunting (TIPS) at our institution and to determine risk factors for their occurrence.
We retrospectively reviewed records of all patients who underwent TIPS in our institution between 1996 and 2009. Data included: indications for TIPS, underlying liver disease, demographics, positive blood cultures after TIPS, microbiological characteristics, treatment and outcome.
49 men and 47 women were included with a mean age of 55.8 years (range 15-84). Indications for TIPS included variceal bleeding, refractory ascites, hydrothorax and hepatorenal syndrome. Positive blood cultures after TIPS were found in 39/96 (40%) patients at various time intervals following the procedure. Seven patients had persistent bacteremia fitting the definition of endotipsitis. Staphylococcus species grew in 66% of the positive cultures, Candida and enterococci species in 15% each of the isolates, and 3% cultures grew other species. Multi-variate regression analysis identified 4 variables: hypothyroidism, HCV, prophylactic use of antibiotics and the procedure duration as independent risk factors for positive blood cultures following TIPS (P < 0.0006, 0.005, 0.001, 0.0003, respectively). Prophylactic use of antibiotics before the procedure was associated with a decreased risk for bacteremia, preventing mainly early infections, occurring within 120 d of the procedure.
Bacteremia is common following TIPS. Risk factors associated with bacteremia include failure to use prophylactic antibiotics, hypothyroidism, HCV and a long procedure. Our results strongly support the use of prophylaxis as a means to decrease early post TIPS infections.
识别我院经颈静脉肝内门体分流术（TIPS）后所有的菌血症和疑似内支架感染病例，并确定其发生的危险因素。
我们回顾性分析了1996年至2009年间在我院接受TIPS治疗的所有患者的记录。数据包括：TIPS的适应证、潜在肝病、人口统计学资料、TIPS后血培养阳性结果、微生物学特征、治疗及转归。
纳入49例男性和47例女性，平均年龄55.8岁（范围15 - 84岁）。TIPS的适应证包括静脉曲张出血、难治性腹水、胸腔积液和肝肾综合征。在术后不同时间间隔，96例患者中有39例（40%）血培养阳性。7例患者有符合内支架感染定义的持续性菌血症。66%的阳性培养物中培养出葡萄球菌属，念珠菌属和肠球菌属各占分离株的15%，3%的培养物培养出其他菌种。多因素回归分析确定了4个变量：甲状腺功能减退、丙型肝炎病毒（HCV）、预防性使用抗生素和手术持续时间是TIPS后血培养阳性的独立危险因素（P分别<0.0006、0.005、0.001、0.0003）。术前预防性使用抗生素与菌血症风险降低相关，主要预防术后120天内发生的早期感染。
TIPS后菌血症很常见。与菌血症相关的危险因素包括未使用预防性抗生素、甲状腺功能减退、HCV和手术时间长。我们的结果有力支持使用预防性措施作为降低TIPS术后早期感染的一种手段。
