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

Ramirez, Francisco C.; Osato, Michael S.; Graham, David Y.; Woods, Karen

doi:10.1111/j.1751-2980.2010.00444.x

Cited by 8 publications

(5 citation statements)

References 46 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: 71%

“…This concerns particularly patients with hilar strictures and PSC [19]. Patients with post-transplant biliary strictures undergoing ERC represent other feasible candidates for systemic antibiotic prophylaxis [21]. Since systemically administered antibiotics poorly penetrate into the bile in case of biliary obstruction [20, 25, 26], a theoretical benefit of injecting antimicrobial agents directly into the bile tracts during ERC is assumable.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, this regimen is supposed to be especially effective in preventing ERC-related cholangiosepsis. Indeed, in vitro studies have demonstrated that addition of gentamicin to the ERC contrast media eliminated bacteriobilia [21]. In a high-risk study population, the combination of intravenous and intraductal antibiotic administration was shown to efficiently prevent post-ERC infectious complications [22].…”

Section: Introductionmentioning

confidence: 99%

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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: 71%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Several previous studies showed that patients with obstructed bile ducts are at highest risk of developing septic complications following ERCP, especially when the drainage was not complete 3,10,11. And poorly disinfected duodenoscopy was considered as a risk factor of post-ERCP bacteremia especially in Pseudomonas aeruginosa infection 12.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Post Endoscopic Retrograde Cholangiopancreatography Bacteremia

Kwak

Jang

Ryu³

et al. 2013

Gut Liver

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Background/AimsBacteremia following endoscopic retrograde cholangiopancreatography (ERCP) is a severe complication, but the risk factors for this condition have not yet been clearly determined. Thus, the aim of this study was to investigate the risk factors of post-ERCP bacteremia.MethodsAmong patients who underwent ERCP from June 2006 to May 2009, we selected patients without any signs of infection prior to the ERCP procedures. Of these patients, we further selected those who experienced bacteremia after ERCP as well as two-fold age and sex-matched controls who did not experience bacteremia after ERCP procedures. We compared clinical, laboratory and technical aspects between these two groups.ResultsThere were 70 patients (3.1%) who developed bacteremia after ERCP. In the multivariate analysis, a history of previous liver transplantation, an elevated serum alkaline phosphatase level and an endoscopic retrograde biliary drainage procedure were independent risk factors of post-ERCP bacteremia (p=0.006, p=0.001, and p=0.004, respectively). The microbiologic analysis revealed the presence of gram-negative organisms in 80% of the cases, and 11 patients had infections with bacteria expressing extended spectrum β-lactamases. Pseudomonas infection was significantly more common in patients who received liver transplantation as compared to patients without transplantation (p=0.014).ConclusionsA history of liver transplantation, elevated serum alkaline phosphatase levels and endoscopic retrograde biliary drainage procedure were independent risk factors of post-ERCP bacteremia and require additional attention in future studies.

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“…In a study done in Texas, Gentamycin incorporated into the contrast material was successful in reducing the rates of post-ERCP bacteremia. [10] In another study, antibiotics were used parenterally prior to ERCP but failed to produce any significant change in the incidence of bacteremia. [11]…”

Section: Discussionmentioning

confidence: 99%

Acinetobacter baumannii bacteremia, a rare complication of endoscopic retrograde cholagiopancreatography!

et al. 2014

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

Abstract: These results support the use of gentamicin in the contrast medium injected into the biliary system as an ancillary method to prevent post-ERCP sepsis.

Cited by 8 publications

References 46 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

Risk Factors of Post Endoscopic Retrograde Cholangiopancreatography Bacteremia

Acinetobacter baumannii bacteremia, a rare complication of endoscopic retrograde cholagiopancreatography!

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