Research Article
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Endoscopic retrograde cholangiopancreatography sonrası gelişen bakteriyemide eşlik eden risk faktörleri

Year 2020, Volume: 4 Issue: 1, 48 - 52, 02.01.2020
https://doi.org/10.28982/josam.673577

Abstract

Amaç: Endoskopik retrograd kolanjiyopankreatografi (ERCP) sonrası bakteriyemi ciddi bir komplikasyondur, ancak bu komplikasyon için risk faktörleri henüz net olarak tanımlanmamıştır. Bu çalışmada ERCP sonrası bakteriyemi ve ilişkili risk faktörlerinin insidansını belirlemeyi amaçladık.

Yöntemler: Bu retrospektif-kohort çalışma Ocak 2017-Aralık 2018 tarihleri arasında yapıldı. İşlem öncesi enfeksiyon belirtisi olmayan ve işlem sonrası bakteriyemi gelişen hastalar çalışmaya alındı. Bakteriyemi gelişen her hasta için ERCP uygulanan ve bakteriyemi geliştirmeyen iki randomize kontrol hastası risk faktörlerini, klinik ve laboratuvar bulgularını karşılaştırmak için seçildi.

Bulgular: ERCP prosedürü uygulanan 4237 hastanın 86'sında toplam 91 bakteriyemi atağı tespit edildi. ERCP sonrası bakteriyemi oranı % 2 olarak bulundu. Çok değişkenli analizde, hastanın yaşı, safra yolları kanseri, kolesistit / kolanjit, pankreatit ve biyopsi bakteriyemi için anlamlı risk faktörleri olarak bulundu (sırasıyla P=0,009, P<0,001, P=0,008, P=0,002 ve P=0,014) .

Sonuç: ERCP sonrası bakteriyemi gelişimi mortalite riskini önemli ölçüde artırmaktadır. Çalışmamızda, kaybedilen hastaların yaş ortalaması daha büyüktü. Bu sonuç, özellikle yaşlı hastalarda profilaktik antibiyotik kullanımını destekler niteliktedir. Potansiyel ERCP komplikasyonları ve risk faktörleri hakkındaki bilgi sahibi olmanın, komplikasyon insidansını ve şiddetini azaltmaya yardımcı olabileceğini düşünüyoruz.

References

  • 1. Ong TZ, Khor JL, Selamat DS, Yeoh KG, Ho KY. Complications of endoscopic retrograde cholangiography in the post-MRCP era: a tertiary center experience. World J Gastroenterol. 2005 Sep 7;11(33):5209-12.
  • 2. Çalışkan YK, Kalaycı MU. Can failure of choledochal cannulation in endoscopic retrograde cholangiopancreatography be prevented? J Surg Med. 2018;2(3):253-6.
  • 3. Kwak MS, Jang ES, Ryu JK, Kim YT, Yoon YB, Park JK. Risk factors of post endoscopic retrograde cholangiopancreatography bacteremia. Gut Liver. 2013 Mar;7(2):228-33.
  • 4. Coelho-Prabhu N, Shah ND, Van Houten H, Kamath PS, Baron TH. Endoscopic retrograde cholangiopancreatography: utilisation and outcomes in a 10-year population-based cohort. BMJ Open. 2013 May 31;3(5).
  • 5. Anderson DJ, Shimpi RA, McDonald JR, Branch MS, Kanafani ZA, Harger J, et al. Infectious complications following endoscopic retrograde cholangiopancreatography: an automated surveillance system for detecting postprocedure bacteremia. Am J Infect Control. 2008 Oct;36(8):592-4.
  • 6. Du M, Suo J, Liu B, Xing Y, Chen L, Liu Y. Post-ERCP infection and its epidemiological and clinical characteristics in a large Chinese tertiary hospital: a 4-year surveillance study. Antimicrob Resist Infect Control. 2017 Dec 29;6:131.
  • 7. Szary NM, Al-Kawas FH. Complications of endoscopic retrograde cholangiopancreatography: how to avoid and manage them. Gastroenterol Hepatol (N Y). 2013 Aug;9(8):496-504.
  • 8. Pannu HK, Fishman EK. Complications of endoscopic retrograde cholangiopancreatography: spectrum of abnormalities demonstrated with CT. Radiographics. 2001 Nov-Dec;21(6):1441-53.
  • 9. Anderson MA, Fisher L, Jain R, et al. ASGE Standards of Practice Committee. Guideline complications of ERCP. Gastrointest Endosc. 2012;75(3):467-73.
  • 10. Jain PK, Vinay BN. Indications and complications of endoscopic retrograde cholangiopancreatography procedures in a tertiary care centre. Int J Adv Med. 2016 Nov;3(4):838-41.
  • 11. Identifying Healthcare-associated Infections (HAI) for NHSN Surveillance. https://www.cdc.gov/nhsn/pdfs/pscmanual/2psc_identifyinghais_nhsncurrent.pdf. Accessed 30 Aug 2017.
  • 12. Tarnasky PR, Kedia P. Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies. Gastrointest Interv. 2017;6:37–53.
  • 13. Borges AC, Almeida PC, Furlani SMT, Cury MS, Pleskow DK. ERCP performance in a tertiary Brazilian Center: Focus on New Risk Factors, Complications and Quality Indicators. Arq Bras Cir Dig. 2018 Jun 21;31(1):e1348.
  • 14. Tonolini M, Pagani A, Bianco R. Cross-sectional imaging of common and unusual complications after endoscopic retrograde cholangiopancreatography. Insights Imaging. 2015 Jun;6(3):323-38.
  • 15. Novello P, Hagège H, Ducreux M, Buffet C, Choury A, Fritsch J, Liguory C, Jacques L, Etienne JP. Septicemias after endoscopic retrograde cholangiopancreatography. Risk factors and antibiotic prophylaxis. Gastroenterol Clin Biol. 1993;17(12):897-902.
  • 16. Wobser H, Gunesch A, Klebl F.Prophylaxis of post-ERC infectious complications in patients with biliary obstruction by adding antimicrobial agents into ERC contrast media- a single center retrospective study. BMC Gastroenterol. 2017 Jan 13;17(1):10.
  • 17. Juan J Vila, Everson LA Artifon, Jose Pinhata Otoch. Post-endoscopic retrograde cholangiopancreatography complications: How can they be avoided? World J Gastrointest Endosc. 2012 Jun 16;4(6):241–6.
  • 18. Dutta SK, Cox M, Williams RB, Eisenstat TE, Standiford HC. Prospective evaluation of the risk of bacteremia and the role of antibiotics in ERCP. J Clin Gastroenterol. 1983 Aug;5(4):325-9.
  • 19. Thosani N, Zubarik RS, Kochar R, Kothari S, Sardana N, Nguyen T, et al. Prospective evaluation of bacteremia rates and infectious complications among patients undergoing single-operator choledochoscopy during ERCP. Endoscopy. 2016 May;48(5):424-31.
  • 20. Mollison LC, Desmond PV, Stockman KA, Andrew JH, Watson K, Shaw G, et al. A prospective study of septic complications of endoscopic retrograde cholangiopancreatography. J Gastroenterol Hepatol. 1994 Jan-Feb;9(1):55-9.
  • 21. Devière J, Motte S, Dumonceau JM, Serruys E, Thys JP, Cremer M. Septicemia after endoscopic retrograde cholangiopancreatography. Endoscopy. 1990 Mar;22(2):72-5.
  • 22. Motte S1, Deviere J, Dumonceau JM, Serruys E, Thys JP, Cremer M. Risk factors for septicemia following endoscopic biliary stenting. Gastroenterology. 1991 Nov;101(5):1374-81.
  • 23. Rupp C, Bode K, Weiss KH, Rudolph G, Bergemann J, Kloeters-Plachky P, et al. Microbiological Assessment of Bile and Corresponding Antibiotic Treatment: A Strobe-Compliant Observational Study of 1401 Endoscopic Retrograde Cholangiographies. Medicine (Baltimore). 2016 Mar;95(10):e2390

Risk factors for bacteremia following endoscopic retrograde cholangiopancreatography

Year 2020, Volume: 4 Issue: 1, 48 - 52, 02.01.2020
https://doi.org/10.28982/josam.673577

Abstract

Aim: Bacteremia after endoscopic retrograde cholangiopancreatography (ERCP) is a serious complication, but its risk factors have not yet been clearly defined. In this study, we aimed to determine the incidence of bacteremia and associated risk factors after ERCP.
Methods: This retrospective-cohort study was conducted between January 2017 and December 2018. Patients who had no signs of infection before the procedure and who developed bacteremia after the procedure were included in the study. For each patient who developed bacteremia, two randomized control patients who underwent ERCP and did not develop bacteremia were selected to compare risk factors, clinical and laboratory findings. 
Results: A total of 91 bacteremia attacks were detected in 86 of the 4237 patients who underwent ERCP procedure. Bacteremia rate after ERCP was 2%. In multivariate analysis, the age of the patient, presence of biliary tract cancer, cholecystitis / cholangitis, pancreatitis and biopsy were determined as significant risk factors for post-ERCP bacteremia (P=0.009, P<0.001, P=0.008, P=0.002 and P=0.014 respectively). 
Conclusion: The development of bacteremia after ERCP significantly increases the risk of mortality. The mean age of the patients who died was older. This result supports the use of prophylactic antibiotics especially in elderly patients. We think that knowledge of potential ERCP complications and risk factors may help reduce the incidence and severity of complications.

References

  • 1. Ong TZ, Khor JL, Selamat DS, Yeoh KG, Ho KY. Complications of endoscopic retrograde cholangiography in the post-MRCP era: a tertiary center experience. World J Gastroenterol. 2005 Sep 7;11(33):5209-12.
  • 2. Çalışkan YK, Kalaycı MU. Can failure of choledochal cannulation in endoscopic retrograde cholangiopancreatography be prevented? J Surg Med. 2018;2(3):253-6.
  • 3. Kwak MS, Jang ES, Ryu JK, Kim YT, Yoon YB, Park JK. Risk factors of post endoscopic retrograde cholangiopancreatography bacteremia. Gut Liver. 2013 Mar;7(2):228-33.
  • 4. Coelho-Prabhu N, Shah ND, Van Houten H, Kamath PS, Baron TH. Endoscopic retrograde cholangiopancreatography: utilisation and outcomes in a 10-year population-based cohort. BMJ Open. 2013 May 31;3(5).
  • 5. Anderson DJ, Shimpi RA, McDonald JR, Branch MS, Kanafani ZA, Harger J, et al. Infectious complications following endoscopic retrograde cholangiopancreatography: an automated surveillance system for detecting postprocedure bacteremia. Am J Infect Control. 2008 Oct;36(8):592-4.
  • 6. Du M, Suo J, Liu B, Xing Y, Chen L, Liu Y. Post-ERCP infection and its epidemiological and clinical characteristics in a large Chinese tertiary hospital: a 4-year surveillance study. Antimicrob Resist Infect Control. 2017 Dec 29;6:131.
  • 7. Szary NM, Al-Kawas FH. Complications of endoscopic retrograde cholangiopancreatography: how to avoid and manage them. Gastroenterol Hepatol (N Y). 2013 Aug;9(8):496-504.
  • 8. Pannu HK, Fishman EK. Complications of endoscopic retrograde cholangiopancreatography: spectrum of abnormalities demonstrated with CT. Radiographics. 2001 Nov-Dec;21(6):1441-53.
  • 9. Anderson MA, Fisher L, Jain R, et al. ASGE Standards of Practice Committee. Guideline complications of ERCP. Gastrointest Endosc. 2012;75(3):467-73.
  • 10. Jain PK, Vinay BN. Indications and complications of endoscopic retrograde cholangiopancreatography procedures in a tertiary care centre. Int J Adv Med. 2016 Nov;3(4):838-41.
  • 11. Identifying Healthcare-associated Infections (HAI) for NHSN Surveillance. https://www.cdc.gov/nhsn/pdfs/pscmanual/2psc_identifyinghais_nhsncurrent.pdf. Accessed 30 Aug 2017.
  • 12. Tarnasky PR, Kedia P. Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies. Gastrointest Interv. 2017;6:37–53.
  • 13. Borges AC, Almeida PC, Furlani SMT, Cury MS, Pleskow DK. ERCP performance in a tertiary Brazilian Center: Focus on New Risk Factors, Complications and Quality Indicators. Arq Bras Cir Dig. 2018 Jun 21;31(1):e1348.
  • 14. Tonolini M, Pagani A, Bianco R. Cross-sectional imaging of common and unusual complications after endoscopic retrograde cholangiopancreatography. Insights Imaging. 2015 Jun;6(3):323-38.
  • 15. Novello P, Hagège H, Ducreux M, Buffet C, Choury A, Fritsch J, Liguory C, Jacques L, Etienne JP. Septicemias after endoscopic retrograde cholangiopancreatography. Risk factors and antibiotic prophylaxis. Gastroenterol Clin Biol. 1993;17(12):897-902.
  • 16. Wobser H, Gunesch A, Klebl F.Prophylaxis of post-ERC infectious complications in patients with biliary obstruction by adding antimicrobial agents into ERC contrast media- a single center retrospective study. BMC Gastroenterol. 2017 Jan 13;17(1):10.
  • 17. Juan J Vila, Everson LA Artifon, Jose Pinhata Otoch. Post-endoscopic retrograde cholangiopancreatography complications: How can they be avoided? World J Gastrointest Endosc. 2012 Jun 16;4(6):241–6.
  • 18. Dutta SK, Cox M, Williams RB, Eisenstat TE, Standiford HC. Prospective evaluation of the risk of bacteremia and the role of antibiotics in ERCP. J Clin Gastroenterol. 1983 Aug;5(4):325-9.
  • 19. Thosani N, Zubarik RS, Kochar R, Kothari S, Sardana N, Nguyen T, et al. Prospective evaluation of bacteremia rates and infectious complications among patients undergoing single-operator choledochoscopy during ERCP. Endoscopy. 2016 May;48(5):424-31.
  • 20. Mollison LC, Desmond PV, Stockman KA, Andrew JH, Watson K, Shaw G, et al. A prospective study of septic complications of endoscopic retrograde cholangiopancreatography. J Gastroenterol Hepatol. 1994 Jan-Feb;9(1):55-9.
  • 21. Devière J, Motte S, Dumonceau JM, Serruys E, Thys JP, Cremer M. Septicemia after endoscopic retrograde cholangiopancreatography. Endoscopy. 1990 Mar;22(2):72-5.
  • 22. Motte S1, Deviere J, Dumonceau JM, Serruys E, Thys JP, Cremer M. Risk factors for septicemia following endoscopic biliary stenting. Gastroenterology. 1991 Nov;101(5):1374-81.
  • 23. Rupp C, Bode K, Weiss KH, Rudolph G, Bergemann J, Kloeters-Plachky P, et al. Microbiological Assessment of Bile and Corresponding Antibiotic Treatment: A Strobe-Compliant Observational Study of 1401 Endoscopic Retrograde Cholangiographies. Medicine (Baltimore). 2016 Mar;95(10):e2390
There are 23 citations in total.

Details

Primary Language English
Subjects Infectious Diseases
Journal Section Research article
Authors

Ayhanım Tümtürk 0000-0002-0653-6725

Cigdem Ataman Hatipoglu 0000-0002-1104-8232

Publication Date January 2, 2020
Published in Issue Year 2020 Volume: 4 Issue: 1

Cite

APA Tümtürk, A., & Ataman Hatipoglu, C. (2020). Risk factors for bacteremia following endoscopic retrograde cholangiopancreatography. Journal of Surgery and Medicine, 4(1), 48-52. https://doi.org/10.28982/josam.673577
AMA Tümtürk A, Ataman Hatipoglu C. Risk factors for bacteremia following endoscopic retrograde cholangiopancreatography. J Surg Med. January 2020;4(1):48-52. doi:10.28982/josam.673577
Chicago Tümtürk, Ayhanım, and Cigdem Ataman Hatipoglu. “Risk Factors for Bacteremia Following Endoscopic Retrograde Cholangiopancreatography”. Journal of Surgery and Medicine 4, no. 1 (January 2020): 48-52. https://doi.org/10.28982/josam.673577.
EndNote Tümtürk A, Ataman Hatipoglu C (January 1, 2020) Risk factors for bacteremia following endoscopic retrograde cholangiopancreatography. Journal of Surgery and Medicine 4 1 48–52.
IEEE A. Tümtürk and C. Ataman Hatipoglu, “Risk factors for bacteremia following endoscopic retrograde cholangiopancreatography”, J Surg Med, vol. 4, no. 1, pp. 48–52, 2020, doi: 10.28982/josam.673577.
ISNAD Tümtürk, Ayhanım - Ataman Hatipoglu, Cigdem. “Risk Factors for Bacteremia Following Endoscopic Retrograde Cholangiopancreatography”. Journal of Surgery and Medicine 4/1 (January 2020), 48-52. https://doi.org/10.28982/josam.673577.
JAMA Tümtürk A, Ataman Hatipoglu C. Risk factors for bacteremia following endoscopic retrograde cholangiopancreatography. J Surg Med. 2020;4:48–52.
MLA Tümtürk, Ayhanım and Cigdem Ataman Hatipoglu. “Risk Factors for Bacteremia Following Endoscopic Retrograde Cholangiopancreatography”. Journal of Surgery and Medicine, vol. 4, no. 1, 2020, pp. 48-52, doi:10.28982/josam.673577.
Vancouver Tümtürk A, Ataman Hatipoglu C. Risk factors for bacteremia following endoscopic retrograde cholangiopancreatography. J Surg Med. 2020;4(1):48-52.