Sauter G, Grabein B, Huber G, Mannes G A, Ruckdeschel G, Sauerbruch T
Medical Department II, University of Munich.
Endoscopy. 1990 Jul;22(4):164-7. doi: 10.1055/s-2007-1012830.
Biliary sepsis represents a major percentage of fatal complications after endoscopic retrograde cholangiopancreatography. We performed a randomized controlled study to investigate the value of antibiotic prophylaxis, and to assess the frequency and source of infectious complications associated with ERCP. Ninety-six patients who underwent 100 endoscopic retrograde cholangiopancreatographies were included in the study. Half of the patients received antibiotic prophylaxis (Cefotaxime 2 g i.v. 15 min before the procedure). Bacteremia was detected in 2% of the patients receiving antibiotic prophylaxis, as compared with 16% (p less than 0.02) in the control group. In order to determine the source of bacteremia, bile samples and irrigation fluid from the suction channel of the endo-scope were obtained for bacteriological evaluation. Several lines of evidence suggested that bacteremia associated with ERCP was essentially caused by mucosal lesions of the oropharynx. Bacteremia was asymptomatic, with the exception of two patients who subsequently developed fever, but recovered rapidly under antibiotic therapy. The frequency of cholangitis following ERCP was not significantly reduced by antibiotic prophylaxis (4% vs. 2%). Recommendations for antibiotic prophylaxis are discussed.
胆管败血症是内镜逆行胰胆管造影术后致命并发症的主要组成部分。我们进行了一项随机对照研究，以探讨抗生素预防的价值，并评估与内镜逆行胰胆管造影术相关的感染性并发症的发生率和来源。本研究纳入了96例接受100次内镜逆行胰胆管造影术的患者。一半患者接受抗生素预防（头孢噻肟2g静脉注射，在操作前15分钟给药）。接受抗生素预防的患者中2%检测到菌血症，而对照组为16%（p<0.02）。为了确定菌血症的来源，获取了胆汁样本和来自内镜吸引通道的冲洗液进行细菌学评估。多项证据表明，与内镜逆行胰胆管造影术相关的菌血症主要由口咽部黏膜病变引起。菌血症无症状，除了两名患者随后出现发热，但在抗生素治疗下迅速康复。抗生素预防并未显著降低内镜逆行胰胆管造影术后胆管炎的发生率（4%对2%）。讨论了抗生素预防的建议。
