TY - JOUR
T1 - SCEPTICEMIES APRES CHOLANGIOPANCREATOGRAPHIE RETROGRADE ENDOSCOPIQUE. FACTEURS DE RISQUE ET ANTIBIOPROPHYLAXIE
AU - Novello, P.
AU - Hagege, H.
AU - Ducreux, M.
AU - Buffet, C.
AU - Choury, A.
AU - Fritsch, J.
AU - Liguory, C.
AU - Jacques, L.
AU - Etienne, J. P.
PY - 1993/12/1
Y1 - 1993/12/1
N2 - The infection following endoscopic retrograde cholangiopancreatography (ERCP) is one of the most severe complications. The aim of the present study was to assess the prevalence and the prognosis of this complication, to look for the risk factors and to define bacterial ecology in order to put forward the most appropriate antibiotherapy. Two thousand and ten patients were included in this study. Among these, 51 (2.5%) had a septic complication following ERCP. Endoscopy biliary drainage was complete in 24 cases, incomplete in 19 and lacking in 8. Transhepatic biliary drainage was carried out in 17 cases. Sixteen patients (31%) with tumor obstructions died within 30 days after ERCP. Four risk factors were isolated when comparing infected patients with other patients: the completeness of biliary obstruction (90 vs 48%, P < 0.001); multiple cannulation attempts (1.76 ± 1.12 vs 1.25 ± 0.70, P < 0.001), the malignant nature of the obstruction (80 vs 23%, P < 0.002) and the lack of satisfactory drainage following endoscopy (53 vs 23%, P = 0.009). Pseudomonas aeruginosa was the most frequently isolated species, both from blood cultures (30%) and bile samples (23%). The preventive therapy of septic complications following ERCP must include strict rules concerning the disinfection of endoscopic material. We believe that for patients with malignant obstruction of the biliary tree, an efficient antibioprophylaxis against P. aeruginosa should be applied (imipenem/cilastatin monotherapy or ciprofloxacin-amoxicillin combination). The curative therapy of septic complications following ERCP mainly relies on the efficient drainage of the biliary tree that can only be achieved through transhepatic or intra-operative drainage. The main goal of antibiotherapy is to lower septicaemic spread of biliary infection; obviously, this antibiotherapy must fit the nature of the species isolated from bile and blood. Before bacteriological data are available, the imipenem/cilastatin-amikacin combination represents the first-line treatment in such patients.
AB - The infection following endoscopic retrograde cholangiopancreatography (ERCP) is one of the most severe complications. The aim of the present study was to assess the prevalence and the prognosis of this complication, to look for the risk factors and to define bacterial ecology in order to put forward the most appropriate antibiotherapy. Two thousand and ten patients were included in this study. Among these, 51 (2.5%) had a septic complication following ERCP. Endoscopy biliary drainage was complete in 24 cases, incomplete in 19 and lacking in 8. Transhepatic biliary drainage was carried out in 17 cases. Sixteen patients (31%) with tumor obstructions died within 30 days after ERCP. Four risk factors were isolated when comparing infected patients with other patients: the completeness of biliary obstruction (90 vs 48%, P < 0.001); multiple cannulation attempts (1.76 ± 1.12 vs 1.25 ± 0.70, P < 0.001), the malignant nature of the obstruction (80 vs 23%, P < 0.002) and the lack of satisfactory drainage following endoscopy (53 vs 23%, P = 0.009). Pseudomonas aeruginosa was the most frequently isolated species, both from blood cultures (30%) and bile samples (23%). The preventive therapy of septic complications following ERCP must include strict rules concerning the disinfection of endoscopic material. We believe that for patients with malignant obstruction of the biliary tree, an efficient antibioprophylaxis against P. aeruginosa should be applied (imipenem/cilastatin monotherapy or ciprofloxacin-amoxicillin combination). The curative therapy of septic complications following ERCP mainly relies on the efficient drainage of the biliary tree that can only be achieved through transhepatic or intra-operative drainage. The main goal of antibiotherapy is to lower septicaemic spread of biliary infection; obviously, this antibiotherapy must fit the nature of the species isolated from bile and blood. Before bacteriological data are available, the imipenem/cilastatin-amikacin combination represents the first-line treatment in such patients.
KW - Pseudomonas aeruginosa
KW - antibioprophylaxis
KW - biliary drainage
KW - cancer of biliary tree
KW - endoscopic retrograde cholangio-pancreatography (ERCP)
KW - septicaemia
UR - http://www.scopus.com/inward/record.url?scp=0027733340&partnerID=8YFLogxK
M3 - Article
C2 - 8125221
AN - SCOPUS:0027733340
SN - 0399-8320
VL - 17
SP - 897
EP - 902
JO - Gastroenterologie Clinique et Biologique
JF - Gastroenterologie Clinique et Biologique
IS - 12
ER -