Thosani Nirav, Zubarik Richard S, Kochar Rajan, Kothari Shivangi, Sardana Neeraj, Nguyen Tu, Banerjee Subhas
Division of Gastroenterology and Hepatology, Stanford University, Stanford, California, United States.
Gastroenterology and Hepatology, University of Vermont Hospitals, Burlington, Vermont, United States.
Endoscopy. 2016 May;48(5):424-31. doi: 10.1055/s-0042-101407. Epub 2016 Feb 26.
Choledochoscopy is increasingly performed during endoscopic retrograde cholangiopancreatography (ERCP) for direct bile duct visualization. Choledochoscopy necessitates irrigation of the bile duct with water or saline, which may increase intrabiliary pressure and consequently the risks of bacteremia and cholangitis. The aim of this study was to prospectively evaluate the risk of bacteremia and infectious complications in patients undergoing single-operator choledochoscopy (SOC).
Patients requiring ERCP with SOC at two tertiary care centers were enrolled prospectively. Blood cultures were obtained immediately before the ERCP, after completion of the ERCP portion of the procedure (to determine ERCP-related bacteremia), and 15 minutes after completion of SOC.
A total of 72 patients (mean age 64 years; 51.4 % male) underwent ERCP with SOC. True positive blood cultures were noted in 20 patients (27.8 %; 95 % confidence interval [CI] 17.86 % - 39.59 %), of whom 6 patients (8.3 %; 95 %CI 3.12 % - 17.26 %) had transient bacteremia following ERCP. Of 14 patients (19.4 %; 95 %CI 11.05 % - 30.46 %) with sustained bacteremia following ERCP or SOC, 10 patients (13.9 %; 95 %CI 6.86 % - 24.06 %) had sustained bacteremia related to SOC. Despite the use of post-procedure intravenous antibiotic administration, seven patients (9.7 %; 95 %CI 3.99 - 19.01 %) required further antibiotic treatment for infectious complications, three of whom (4.2 %; 95 %CI 0.86 % - 11.69 %) were hospitalized in order to receive intravenous antibiotic therapy.
The bacteremia associated with ERCP with SOC and the subsequent risk of hospitalization for infectious complications suggest that preprocedure antibiotic prophylaxis should be considered for patients undergoing SOC, particularly in older patients and those with prior stent placement or undergoing intraductal stone lithotripsy.
clinical trials.gov (NCT01414400).
在进行内镜逆行胰胆管造影术（ERCP）时，越来越多地会进行胆管镜检查以直接观察胆管。胆管镜检查需要用水或生理盐水冲洗胆管，这可能会增加胆管内压力，进而增加菌血症和胆管炎的风险。本研究的目的是前瞻性评估接受单人操作胆管镜检查（SOC）患者的菌血症和感染性并发症风险。
前瞻性纳入两家三级医疗中心需要接受ERCP联合SOC的患者。在ERCP术前即刻、完成ERCP操作部分后（以确定与ERCP相关的菌血症）以及SOC完成后15分钟采集血培养样本。
共有72例患者（平均年龄64岁；51.4%为男性）接受了ERCP联合SOC。20例患者（27.8%；95%置信区间[CI] 17.86% - 39.59%）血培养结果为真阳性，其中6例患者（8.3%；95%CI 3.12% - 17.26%）在ERCP术后出现短暂菌血症。在ERCP或SOC术后发生持续性菌血症的14例患者（19.4%；95%CI 11.05% - 30.46%）中，10例患者（13.9%；95%CI 6.86% - 24.06%）的持续性菌血症与SOC相关。尽管术后使用了静脉抗生素治疗，但7例患者（9.7%；95%CI 3.99 - 19.01%）因感染性并发症需要进一步抗生素治疗，其中3例患者（4.2%；95%CI 0.86% - 11.69%）需住院接受静脉抗生素治疗。
与ERCP联合SOC相关的菌血症以及随后因感染性并发症住院的风险表明，对于接受SOC的患者，尤其是老年患者以及既往有支架置入或接受胆管内结石碎石术的患者，应考虑术前预防性使用抗生素。
clinicaltrials.gov（NCT01414400）
