Antibiotics and ERCP: In vitro activity of aminoglycosides when added to iodinated contrast agents

Jendrzejewski, John W.; McANALLY, Thomas P.; Jones, Stephen R.; Katon, Ronald M.

doi:10.1016/0016-5085(80)90678-2

Cited by 21 publications

(5 citation statements)

References 14 publications

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“…In vitro studies have proven that aminoglycosides retain their antibacterial properties when mixed to ERC contrast media. Thus, the aminoglycosides tobramycin and gentamicin efficiently eliminated common biliary bacteria such as E. coli , Klebsiella pneumonia , Proteus vulgaris and Pseudomonas aeruginosa [21, 27]. In line with these findings, we observed a significantly reduced post-ERC infection rate in patients with biliary obstruction when antimicrobial agents were added into the ERC media.…”

Section: Discussionsupporting

confidence: 69%

Prophylaxis of post-ERC infectious complications in patients with biliary obstruction by adding antimicrobial agents into ERC contrast media- a single center retrospective study

2017

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BackgroundPatients with biliary obstruction are at high risk to develop septic complications after endoscopic retrograde cholangiography (ERC). We evaluated the benefits of local application of antimicrobial agents into ERC contrast media in preventing post-ERC infectious complications in a high-risk study population.MethodsPatients undergoing ERC at our tertiary referral center were retrospectively included. Addition of vancomycin, gentamicin and fluconazol into ERC contrast media was evaluated in a case-control design. Outcomes comprised infectious complications within 3 days after ERC.ResultsIn total, 84 ERC cases were analyzed. Primarily indications for ERC were sclerosing cholangitis (75%) and malignant stenosis (9.5%). Microbial testing of collected bile fluid in the treatment group was positive in 91.4%. Detected organisms were sensitive to the administered antimicrobials in 93%. The use of antimicrobials in contrast media was associated with a significant decrease in post-ERC infectious complications compared to non-use (14.3% vs. 33.3%; odds ratio [OR]: 0.33, 95% confidence interval [CI]: 0.114–0.978). After adjusting for the variables acute cholangitis prior to ERC and incomplete biliary drainage, the beneficial effect of intraductal antibiotic prophylaxis was even more evident (OR = 0.153; 95% CI: 0.039–0.598, p = 0.007). Patients profiting most obviously from intraductal antimicrobials were those with secondary sclerosing cholangitis.ConclusionLocal application of a combination of antibiotic and antimycotic agents to ERC contrast media efficiently reduced post-ERC infectious events in patients with biliary obstruction. This is the first study that evaluates ERC-related infectious complications in patients with secondary sclerosing cholangitis. Our first clinical results should now be prospectively evaluated in a larger patient cohort to improve the safety of ERC, especially in patients with secondary sclerosing cholangitis.

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Section: Discussionsupporting

confidence: 69%

Prophylaxis of post-ERC infectious complications in patients with biliary obstruction by adding antimicrobial agents into ERC contrast media- a single center retrospective study

2017

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“…Despite the lack of controlled studies our in vivo experience and the in vitro studies support the concept that local antibiotics are useful for the prevention of post-ERCP infection. Jendrzejewski and other authors [8][9][10][11][12][13][14][15][16][17][18][19]48 have shown that addition of either gentamicin or tobramycin to an iodinated contrast medium prevented the growth of Klebsiella, Proteus and Escherichia coli. The possible bactericidal effect of the hyperosmolar contrast solution, as well as the possibility that either bile or contrast would interfere with the antimicrobial properties of the aminoglycosides tested, have been previously disproved.…”

Section: Discussionmentioning

confidence: 99%

“…The possible bactericidal effect of the hyperosmolar contrast solution, as well as the possibility that either bile or contrast would interfere with the antimicrobial properties of the aminoglycosides tested, have been previously disproved. 48,49 No organisms resistant to aminoglycosides were included in those studies whereas we used a resistant strain actually recovered from a patient with post-ERCP sepsis.…”

Section: Discussionmentioning

confidence: 99%

Addition of gentamicin to endoscopic retrograde cholangiopancreatography (ERCP) contrast medium towards reducing the frequency of septic complications of ERCP

Ramirez

Osato

Graham

et al. 2010

J of Digest Diseases

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“…Acute pancreatitis is the main complication of ERCP with a frequency rate of 1% if performed by an expert [10]. These cases are usually slight to moderate and the patients recover after medical treatment.…”

Section: Results Of Diagnostic Endoscopymentioning

confidence: 99%

Malignant jaundice: Results of diagnostic and therapeutic endoscopy

Soehendra¹,

Grimm²,

Berger³

et al. 1989

World j. surg.

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Direct cholangiography plays an important role in the diagnosis of malignant obstructive jaundice. Endoscopic retrograde cholangiopancreatography is gradually gaining ground over percutaneous transhepatic cholangiography. Endoscopy can determine the exact location and extent of the obstruction. Typical changes of the ducts are often helpful in interpreting the causes of obstructive jaundice. Representation of the bile and pancreatic duct systems is successful in 95% of cases in the hands of an expert. Acute pancreatitis is a complication occurring in about 1% of cases. Immediate drainage can usually prevent septic complications. Endoscopic drainage is a palliative measure for inoperable patients. Compared to biliodigestive anastomoses, catheters are subject to clogging in the less-risky, nonsurgical method. Blockage causes late cholangitis which can only be recognized and remedied by regular after-care of the patient. Endoscopic placement of the prosthesis has an 85% rate of success. The rate of complications related to the procedure is 2%. The mortality rate is 1%.

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Antibiotics and ERCP: In vitro activity of aminoglycosides when added to iodinated contrast agents

Cited by 21 publications

References 14 publications

Prophylaxis of post-ERC infectious complications in patients with biliary obstruction by adding antimicrobial agents into ERC contrast media- a single center retrospective study

Prophylaxis of post-ERC infectious complications in patients with biliary obstruction by adding antimicrobial agents into ERC contrast media- a single center retrospective study

Addition of gentamicin to endoscopic retrograde cholangiopancreatography (ERCP) contrast medium towards reducing the frequency of septic complications of ERCP

Malignant jaundice: Results of diagnostic and therapeutic endoscopy

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