Bacteremia following diagnostic and therapeutic ERCP

Kullman, Eric; Borch, Kurt; Lindström, Eva; Ånséhn, S; Ihse, Ingemar; Anderberg, B

doi:10.1016/s0016-5107(92)70474-x

Cited by 68 publications

(34 citation statements)

References 22 publications

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“…We conclude that detecting low-grade pathogens in bile is not clinically relevant, in line with data from others regarding bacteremia after ERCs involving these pathogens. 5,15,16 It is difficult to distinguish between colonization and significant infection. Signs of cholangitis were significantly more often associated with the detection of enteric bacteria, but there were still a substantial number of patients in which we found bacteria without signs of cholangitis.…”

Section: Discussionmentioning

confidence: 99%

Microbiological Assessment of Bile and Corresponding Antibiotic Treatment

et al. 2016

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The aim of this study was to determine the antibiotic susceptibility profiles of bacteria in bile samples and to analyze the clinical relevance of the findings as only limited information about risk factors for elevated frequence of bacterial and fungal strains in routinely collected bile samples has been described so far.A prospective cohort study at a tertiary care center was conducted. Seven hundred forty-four patients underwent 1401 endoscopic retrograde cholangiographies (ERCs) as indicated by liver transplantation (427/1401), primary sclerosing cholangitis (222/1401), choledocholithiasis only (153/1401), obstruction due to malignancy (366/1401), or other conditions (233/1401). Bile samples for microbiological analysis were obtained in all patients.The 71.6% (823/1150) samples had a positive microbiological finding, and 57% (840/1491) of the bacterial isolates were gram-positive. The main species were Enterococcus spp (33%; 494/1491) and Escherichia coli (12%; 179/1491). Of the samples, 53.8% had enteric bacteria and 24.7% had Candida spp; both were associated with clinical and laboratory signs of cholangitis (C-reactive proteins 35.0 ± 50.1 vs 44.8 ± 57.6; 34.5 ± 51.2 vs 52.9 ± 59.7; P < 0.001), age, previous endoscopic intervention, and immunosuppression. Multi-resistant (MR) strains were found in 11.3% of all samples and were associated with clinical and laboratory signs of cholangitis, previous intervention, and immunocompromised status. In subgroup analysis, strain-specific antibiotic therapy based on bile sampling was achieved in 56.3% (89/158) of the patients. In cases with a positive bile culture and available blood culture, blood cultures were positive in 29% of cases (36/124), and 94% (34/36) of blood cultures had microbial species identical to the bile cultures.Bactobilia and fungobilia can usually be detected by routine microbiological sampling, allowing optimized, strain-specific antibiotic treatment. Previous endoscopic intervention, clinical and laboratory signs of cholangitis, and age are independent risk factors. MR bacteria and fungi are an evolving problem in cholangitis, especially in immunocompromised patients.

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Section: Discussionmentioning

confidence: 99%

Microbiological Assessment of Bile and Corresponding Antibiotic Treatment

et al. 2016

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“…The rate of occurrence of bacteremia ranges from 0% to 15% after ERCP of unobstructed pancreatic or bile ducts (96,(301)(302)(303)(304) and from 0% to 27% in patients with biliary obstruction by stones or a tumor (302)(303)(304)(305)(306)(307). Not all bacteremic episodes result in a clinically relevant complication.…”

Section: Diagnostic and Therapeutic Upper Gastrointestinal Endoscopymentioning

confidence: 99%

“…The most frequent organisms responsible for cholangitis/sepsis are enteric bacteria, including Enterobacteriaceae (E. coli, Klebsiella spp., and Enterobacter spp. ), enterococci, and a variety of species of alpha-hemolytic streptococci (302,306,323).…”

Section: Diagnostic and Therapeutic Upper Gastrointestinal Endoscopymentioning

confidence: 99%

Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy

et al. 2013

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SUMMARY Flexible endoscopy is a widely used diagnostic and therapeutic procedure. Contaminated endoscopes are the medical devices frequently associated with outbreaks of health care-associated infections. Accurate reprocessing of flexible endoscopes involves cleaning and high-level disinfection followed by rinsing and drying before storage. Most contemporary flexible endoscopes cannot be heat sterilized and are designed with multiple channels, which are difficult to clean and disinfect. The ability of bacteria to form biofilms on the inner channel surfaces can contribute to failure of the decontamination process. Implementation of microbiological surveillance of endoscope reprocessing is appropriate to detect early colonization and biofilm formation in the endoscope and to prevent contamination and infection in patients after endoscopic procedures. This review presents an overview of the infections and cross-contaminations related to flexible gastrointestinal endoscopy and bronchoscopy and illustrates the impact of biofilm on endoscope reprocessing and postendoscopic infection.

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“…Bacteraemia is well recognised during ERCP 51 – 54. Pancreaticobiliary infection occurs after 0.4–0.8% of endoscopic biliary procedures.…”

Section: Endoscopic Retrograde Cholangiopancreatographymentioning

confidence: 99%