Department of Infection Management and Disease Control, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China.
Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China.
Antimicrob Resist Infect Control. 2017 Dec 29;6:131. doi: 10.1186/s13756-017-0290-0. eCollection 2017.
Endoscopic retrograde cholangiopancreatography (ERCP) is widely performed as a treatment for biliary and pancreatic illness in China; however, there are few data available regarding post-ERCP infections. This study aimed to describe the overall incidence of post-ERCP infections and the epidemiological characteristics of infected patients in a large tertiary-care hospital in China.
Real-time surveillance was performed from 2012 through 2015 to identify all healthcare-associated infections (HAIs) that occurred after ERCP, using an automatic system. All HAIs (e.g., cholangtitis, bacteremia) were identified by infection control practitioners and doctors. Inpatient data were automatically collected by the surveillance system.
A total of 1743 ERCP operations were included in the study, among these, 132 (7.57%) HAIs were identified. ERCP postoperative infections occurred following different surgical procedures, with infection rates ranging from 3.58 to 13.51%. The most prevalent HAI was biliary tract infection (4.02%), followed by transient bacteremia (1.14%). Overall, 62 cases of bacteremia occurred following ERCP surgery and 34 (54.84%) cases occurred on the day of the operation or 1-day post-surgery. The most prevalent isolates detected during bacteremia were (12/58) and (11/58). A large proportion (72.73%) of the isolates and all of the isolates were resistant to ciprofloxacin. In addition, only 37.50% of the isolates were susceptible to ceftriaxone.
The high incidence of post-ERCP infection and the prevalence of drug resistance suggests that employing second generation cephalosporin or ceftriaxone as the antibiotic of choice for prophylaxis before ERCP, as recommended by the Chinese clinical application of antibacterial drugs guidelines, may not be effective.
内镜逆行胰胆管造影术（ERCP）在中国被广泛应用于治疗胆道和胰腺疾病，但有关 ERCP 术后感染的数据很少。本研究旨在描述中国一家大型三级医院 ERCP 术后感染的总体发生率和感染患者的流行病学特征。
采用自动系统对 2012 年至 2015 年期间发生的所有与医疗相关的感染（HAIs）进行实时监测，感染控制从业者和医生确定所有的 HAIs（如胆管炎、菌血症）。住院数据由监测系统自动收集。
本研究共纳入 1743 例 ERCP 手术，其中 132 例（7.57%）发生 HAIs。ERCP 术后感染发生于不同的手术过程，感染率为 3.58%至 13.51%。最常见的 HAI 是胆道感染（4.02%），其次是短暂性菌血症（1.14%）。总体而言，62 例菌血症发生于 ERCP 术后，其中 34 例（54.84%）发生于手术当天或术后 1 天。血培养最常见的分离株是 和 （12/58 和 11/58）。大量 分离株（72.73%）和所有 分离株对环丙沙星耐药。此外，只有 37.50%的 分离株对头孢曲松敏感。
ERCP 术后感染发生率高，耐药率高，表明按照中国抗菌药物临床应用指导原则推荐，在 ERCP 术前选用第二代头孢菌素或头孢曲松作为预防用抗生素可能效果不佳。
