The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
Faculty of Management, Tel Aviv University, Tel Aviv 6997801, Israel.
World J Gastroenterol. 2020 Nov 7;26(41):6402-6413. doi: 10.3748/wjg.v26.i41.6402.
Clinically significant post-endoscopic retrograde cholangiopancreatography (ERCP) bacteremia (PEB) occurs in up to 5% of cases, while antibiotic prophylaxis is recommended only when an ERCP is unlikely to achieve complete biliary drainage. However, the current recommendations may not cover all potential risk factors for PEB.
To identify novel risk factors for PEB and evaluate appropriateness of antibiotic prophylaxis.
A retrospective study of 1082 ERCP procedures performed between January 2012 - December 2013 in a single tertiary medical center. Data collection included: Demographic and clinical characteristics such as pre and post procedure antibiotic treatment and bacterial blood cultures. Exclusion criteria were: (1) Age < 18 years; (2) Positive bacterial blood culture before ERCP; (3) Scheduled antibiotic treatment prior to ERCP; (4) Hospitalization longer than 14 d before ERCP; and (5) missing critical data. Stepwise Logistic Regression analysis and Decision Tree algorithms were used for prediction modeling of PEB.
A total of 626 ERCPs performed in 434 patients were included. Mean age 66.49 ± 15.4 years and 46.5% were males. PEB prevalence was 3.7%. Antibiotic prophylaxis was administrated in 139/626 (22.2%) cases but was indicated according to the guidelines only in 44/626 (7%) cases. In all the PEB cases, prophylaxis was deemed not indicated. A stepwise logistic regression [receiver operating characteristic (ROC), 0.766], identified 3 variables as independent risk factors for PEB: Age at ERCP ≥ 75 years (OR, 3.780, 95%CI: 1.519-9.408, = 0.004); Tandem EUS/ERCP with fine needle aspiration (FNA) (OR, 14.528, 95%CI: 3.571-59.095, < 0.001); ERCP duration longer than 60 min (OR, 5.396, 95%CI: 1.86-15.656, = 0.002). In a decision tree model (ROC, 0.778) the probability for PEB without any risk factors was 1% regardless of prophylaxis administration.
The prevalence of PEB in our study is similar to previous reports, despite the fact that antibiotic prophylaxis was administrated more readily than recommended. ERCP duration longer than 60 min, tandem EUS-ERCP with FNA and age above 75 years are significant risk factors for PEB. These factors should be further evaluated as indications for prophylactic antibiotic treatment before ERCP.
临床上有意义的内镜逆行胰胆管造影（ERCP）术后菌血症（PEB）发生率高达 5%，而抗生素预防仅在 ERCP 不太可能实现完全胆道引流时推荐使用。然而，目前的建议可能无法涵盖所有 PEB 的潜在危险因素。
确定 PEB 的新危险因素，并评估抗生素预防的适当性。
对 2012 年 1 月至 2013 年 12 月在一家三级医学中心进行的 1082 例 ERCP 手术进行回顾性研究。数据收集包括：术前和术后抗生素治疗和细菌血培养等人口统计学和临床特征。排除标准为：（1）年龄 < 18 岁；（2）ERCP 前有阳性细菌血培养；（3）ERCP 前计划进行抗生素治疗；（4）ERCP 前住院时间超过 14 天；以及（5）关键数据缺失。采用逐步逻辑回归分析和决策树算法对 PEB 进行预测模型分析。
共纳入 434 例患者的 626 例 ERCP。平均年龄为 66.49 ± 15.4 岁，男性占 46.5%。PEB 发生率为 3.7%。626 例 ERCP 中有 139 例（22.2%）给予了抗生素预防，但根据指南仅对 44 例（7%）给予了预防性抗生素。在所有 PEB 病例中，预防均被认为是不必要的。逐步逻辑回归[受试者工作特征（ROC），0.766]确定了 3 个变量为 PEB 的独立危险因素：ERCP 时年龄≥75 岁（OR，3.780，95%CI：1.519-9.408， = 0.004）；超声内镜（EUS）-ERCP 联合细针抽吸（FNA）（OR，14.528，95%CI：3.571-59.095， < 0.001）；ERCP 持续时间超过 60 分钟（OR，5.396，95%CI：1.86-15.656， = 0.002）。在决策树模型（ROC，0.778）中，无论是否给予预防，无任何危险因素的 PEB 概率为 1%。
尽管抗生素预防的使用比推荐的更为广泛，但我们研究中的 PEB 发生率与以往报道相似。ERCP 持续时间超过 60 分钟、EUS-ERCP 联合 FNA 和年龄超过 75 岁是 PEB 的显著危险因素。这些因素应进一步评估作为 ERCP 前预防性抗生素治疗的指征。
