Endoscopy 2018; 50(04): S202
DOI: 10.1055/s-0038-1637664
ESGE Days 2018 ePosters
Georg Thieme Verlag KG Stuttgart · New York

ANTIBIOTIC PROPHYLAXIS IN PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY AND BILIARY DRAINAGE (PTCD), A RETROSPECTIVE MULTICENTER STUDY

AS Turan
1   Radboudumc, Nijmegen, Netherlands
,
SFM Jenniskens
1   Radboudumc, Nijmegen, Netherlands
,
LJ Schultze Kool
1   Radboudumc, Nijmegen, Netherlands
,
JM Martens
2   Rijnstate, Arnhem, Netherlands
,
MJCM Rutten
3   Jeroen Bosch Ziekenhuis, ‘s Hertogenbosch, Netherlands
,
LSF Yo
4   Catharina Ziekenhuis, Eindhoven, Netherlands
,
MJL Van Strijen
5   St. Antonius Ziekenhuis, Nieuwegein, Netherlands
,
PD Siersema
6   Gastroenterology, Radboudumc, Nijmegen, Netherlands
,
EJM Van Geenen
1   Radboudumc, Nijmegen, Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Yearly, over 2500 percutaneous transhepatic cholangiography (PTC) and biliary drainages (PTCD) are performed in the Netherlands. These interventions are mainly used as a treatment for biliary obstruction in case of failed endoscopic biliary cannulation. The 2010 CIRSE and the SIR guidelines advocate antibiotic prophylaxis (ABp) in PTCD procedures (evidence level 5), because transient bacteremia commonly occurs. In many centers, including ours, no standard protocol for ABp in PTCD is applied. Patients receive ABp at the physician's discretion. The effect of ABp has only been studied in case series with no controls included. Therefore, the crucial question unanswered today is whether ABp indeed reduces the risk of severe infectious complications in patients undergoing PTCD.

Methods:

We performed a retrospective study to assess the effect of ABp in adult patients who underwent PTCD. A systematic search in the hospital electronic patient records from one academic and four teaching hospitals from 2011 – 2016 was performed. Primary objective was the occurrence of severe infectious complications (e.g. sepsis, cholangitis, abscess or cholecystitis) within 30 days of the procedure. Secondary objectives and characteristics were: mortality, mechanical complications (bile leakage/biloma, catheter blockage, peritonitis, acute pancreatitis, severe hemorrhage, pneumothorax), age, gender and BMI.

Results:

Of the 224 patients included, 130 (58%) were treated with ABp. In univariate analysis, no significant difference in severe infectious complications between the ABp and control group was observed: 35.4% vs. 47.6%, respectively (p = 0.076). Overall occurrence of infectious complications was 40.6%; cholangitis 26.3% (p = 0.066); sepsis 24.6% (p = 0.212); abscess 2.7% (p = 1.000); cholecystitis 1.3% (p = 0.580). Procedure-related mortality was 4.7% vs. 10.7%, respectively (p = 0.123).

Conclusions:

This retrospective multicenter study shows a non-significant reduction of severe infectious complications by ABp in PTCD-patients. The overall complication rate of PTCD is considerable. The efficacy of antibiotic prophylaxis prior to PTCD should therefore be re-evaluated, preferably in a multicenter RCT.