Antibiotic Prophylaxis in Transcatheter Treatment of Hepatocellular Carcinoma: an Open Randomized Prospective Study of Oral Versus Intravenous Administration

Ebisutani, Chikara; Sato, Shuichi; Nishi, Katsuhisa; Inoue, Hiroshi; Yoshie, Tomoo; Kinoshita, Yoshikazu

doi:10.2169/internalmedicine.49.3173

Cited by 13 publications

(8 citation statements)

References 19 publications

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“…It seems that prophylactic antibiotic treatment is necessary as the fatal infection may exist in HCC patients with the background of HBV and cirrhosis which means the decreased resistance to bacterial infection because of the hepatic functional damage, leukopenia and so on. 18 Reviews in 2017 pointed that the antibiotics is necessary and beneficial even in the absence of risks described above. 4 The primary mechanism for infection was thought most likely contamination of the embolized segment of hepatic parenchyma with biliary pathogens.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of Chinese Patients with Hepatocellular Carcinoma (HCC) undergoing Transcatheter Arterial Chemoembolization (TACE) with or without Prophylactic Antibiotic Therapy

Chen

2018

J Coll Physicians Surg Pak

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Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of Chinese Patients with Hepatocellular Carcinoma (HCC) undergoing Transcatheter Arterial Chemoembolization (TACE) with or without Prophylactic Antibiotic Therapy

Chen

2018

J Coll Physicians Surg Pak

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“…[14] However, other studies have demonstrated that prophylactic antibiotics do not need to be administered to patients prior to TACE. [15,16] Unnecessary antibiotic usage has several potential risks, such as alteration of the intestinal flora and an increase in antibiotic resistance and hospital cost. Here, we report a rare case of hepatic abscess combined with polymicrobial bacteremia in a patient with a history of radical pancreaticoduodenectomy.…”

Section: Discussionmentioning

confidence: 99%

Polymicrobial bacteremia after treatment of transcatheter arterial chemoembolization

Fang

Hang

et al. 2019

Medicine

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Rationale:Bacteremia caused by polymicrobial infections are rare but dangerous. We report a case of hepatic abscess combined with polymicrobial bacteremia in a 49-year-old male patient after surgery and transcatheter arterial chemoembolization (TACE).Patient concerns:The patient was admitted to hospital with metastatic liver cancer for periodic chemotherapy and developed a high fever and tenderness to the liver following surgery and TACE.Diagnosis:Hepatic abscess combined with polymicrobial bacteremia.Interventions:The clinician formulated a therapy in accordance with the drug susceptibility test and the empirical drug use for anaerobic bacteria. A comprehensive treatment plan was adopted, on the basis of the combination of nitrazole and imipenem as anti-infection drugs as well as continuous abscess drainage.Outcomes:After comprehensive therapy, the patient was ultimately discharged without any residual symptoms.Lessons:Bloodstream infection caused by multiple bacteria increases the difficulty of anti-infection treatments, leading to poor treatment outcome and high mortality. Therefore, a fast and accurate diagnosis of polymicrobial bacteremia is key for initiation of an effective antimicrobial treatment. Additionally, pre-operative prophylactic antibiotics are advisable when patients have a history of abdominal surgery and are immune-compromised.

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“…Many institutes still prescribe antibiotics routinely to patients with fever after TACE or RFA [ 22 , 26 ]. Some even recommend the use of prophylactic antibiotics despite a low incidence of infectious complications [ 27 ], probably because infections in patients with impaired liver function often lead to fatal outcomes. However, this excessive antibiotic use also leads to the emergence of antibiotic resistance, increased medical costs, and adverse effects of antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Procalcitonin for Bacterial Infection after Transarterial Chemoembolization or Radiofrequency Ablation for Hepatocellular Carcinoma

Kang

Kim

et al. 2018

Disease Markers

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This prospective observational study aimed at investigating the role of procalcitonin (PCT) in diagnosing bacterial infection and guiding antibiotic therapy for hepatocellular carcinoma (HCC) patients with fever after transarterial chemoembolization (TACE) and/or radiofrequency ablation (RFA). Ninety-seven cases (84 patients) were enrolled. Serum PCT, C-reactive protein (CRP), and white blood cell (WBC) counts were measured on the day of fever onset (day 0) and days 1, 3, 5, and 7 of fever. Empirical antibiotics were initiated only if PCT was ≥0.5 ng/mL or specific infection foci were suspected. An infectious cause was found in nine cases. PCT on day 0 of fever was significantly higher in patients with bacterial infection than in those without infection (P = 0.035). The area under the receiver operating characteristic curve for PCT was 0.715 (95% confidence interval, 0.538–0.892) and was higher than that for CRP (0.598 (0.368–0.828)) or WBC counts (0.502 (0.307–0.697)). In patients undergoing TACE and/or RFA, a significantly lower number of antibiotics were prescribed during the study period than during the prestudy period (P < 0.001). In conclusion, PCT might be a biomarker for diagnosing infection and guiding antibiotic treatment to reduce unnecessary antibiotic use in patients with fever after TACE and/or RFA.

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Antibiotic Prophylaxis in Transcatheter Treatment of Hepatocellular Carcinoma: an Open Randomized Prospective Study of Oral Versus Intravenous Administration

Abstract: Background Transcatheter arterial chemoembolization (TACE)

Cited by 13 publications

References 19 publications

Retrospective Analysis of Chinese Patients with Hepatocellular Carcinoma (HCC) undergoing Transcatheter Arterial Chemoembolization (TACE) with or without Prophylactic Antibiotic Therapy

Retrospective Analysis of Chinese Patients with Hepatocellular Carcinoma (HCC) undergoing Transcatheter Arterial Chemoembolization (TACE) with or without Prophylactic Antibiotic Therapy

Polymicrobial bacteremia after treatment of transcatheter arterial chemoembolization

Predictive Value of Procalcitonin for Bacterial Infection after Transarterial Chemoembolization or Radiofrequency Ablation for Hepatocellular Carcinoma

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