Bacterial Infections Associated with Hepatic Arteriography and Transarterial Embolization for Hepatocellular Carcinoma: A Prospective Study

Abstract

Sepsis and liver abscess are serious complications following transarterial embolization (TAE) for hepatocellular carcinoma (HCC). However, the exact incidence and the necessity of antibiotic prophylaxis remain undetermined. Between November 1996 and November 1997, we prospectively studied bacterial infections in 231 HCC patients who underwent 287 angiographic procedures without antibiotic prophylaxis, including 176 TAEs and 111 hepatic arteriographies (HAs). Four of the 111 HAs were complicated by transient asymptomatic bacteremia. Of the 176 TAEs, 2 were associated with asymptomatic bacteremia, and 7 (4%) were associated with symptomatic bacterial infection, including 3 cases of sepsis, 2 of liver abscess, and 2 of infected biloma. For patients with HCC, TAE was associated with a higher risk of developing symptomatic bacterial infections than was HA (4% vs. 0, respectively; P ‫؍‬ .03). Previous gastrectomy was the only possible risk factor for liver abscess. Finally, early diagnosis and treatment of these infectious complications usually result in successful outcome.

Liver abscess complicating transcatheter arterial embolization

“…Many risk factors for the post-TAE abscess have been suggested and include biliary-entero anastomosis [1,8,10,11,14,15], status post endoscopic papillotomy [8,15], portal vein thrombosis [1,16], biliary disease [1], pneumobilia [10], large tumour size [12,16,17], previous abdominal operation [9] and gastrointestinal malignancy [10]. An analysis of our patients showed similar findings (Table 1), although factors other than large tumour size were found in fewer than half of our patients.…”

“…Recent studies have shown that the incidence varied from 0.1% to 2% [1,[8][9][10][11]. The incidence of post-TAE liver abscess for HCC is slightly lower, which varies from 0% to 1.1% [1,[8][9][10][11][12][13].…”

A prospective study regarding the complications of transcatheter intraarterial lipiodol chemoembolization in patients with hepatocellular carcinoma

“…17 Liver abscess has been reported to be one of the serious side effects of TACE, but is reported to occur at a low incidence of 1.1%. 18 Upper gastrointestinal bleeding was one of the most common complications in the patients in the current study.…”

Multimicrobial Sepsis Including <i>Clostridium perfringens</i> after Chemoembolization of a Single Liver Metastasis from Common Bile Duct Cancer

“…The infection or superinfection of necrotic tissue after embolization may be prevented by prophylactic antibiosis. However, infection rates are 2–4% (4/172 [15]and 7/176 procedures [16]) with a rate of liver abscess in 1.1% (5/452) [17]after chemoembolization without prophylactic antibiosis. Therefore, prophylactic antibiotics have not been administered on a regular basis in our institution.…”

“…Bacteria may ascend through the arterial sheath and the catheter leading to a primarily asymptomatic bacteremia during the embolization procedure. However, in a recently published study, only 2 of 287 (0.7%) catheter-tip cultures yielded Staphylococcus epidermidis and none of the inguinal skin swab and catheter-tip cultures yielded the same microorganism responsible for infectious complications [16]. …”