Association between prophylactic antibiotic use for transarterial chemoembolization and occurrence of liver abscess: a retrospective cohort study

Yoshihara, Shingo; Yamana, Hayato; Akahane, Manabu; Kishimoto, Miwa; Nishioka, Yuichi; Noda, Tatsuya; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo; Kasahara, Kei; Imamura, Tomoaki

doi:10.1016/j.cmi.2021.01.014

Cited by 9 publications

(6 citation statements)

References 23 publications

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“…The guiding principles for the clinical application of antibiotics in China suggest that antibiotics should be used to prevent infection before TACE [ 16 ]. According to Yoshihara et al, prophylactic antibiotic treatment in patients having TACE was linked to a lower risk of liver abscess necessitating surgical intervention [ 17 ]. However, recent findings show that prophylactic antibiotic medication is not always required in the TACE process for HCC patients [ 15 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Prophylactic Use of Antibiotics for Postsurgical Infection in c-TACE and DEB-TACE High-Risk Patients: A Case-Control Study

2022

Journal of Healthcare Engineering

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Objectives. According to recent reports, prophylactic use of antibiotics is not always required in conventional transarterial chemoembolization (c-TACE). However, clinical evidence of prophylactic antibiotics in drug-eluting beads transarterial chemoembolization (DEB-TACE) to prevent postsurgical infection is limited. This study is aimed to evaluate the correlation between the preoperative prophylactic application of antibiotics and postoperative infection in c-TACE or DEB-TACE, especially in a population with a high risk for postsurgical infection. Methods. In this retrospective study, TACE patients diagnosed with hepatic carcinoma (between January 2019 and May 2021) were examined. The case group was given 1.5 g cefuroxime sodium 0.5–1 hour before TACE, while there was no intervention in the control group. The outcomes analyzed were leukocyte count >9.5 × 109/L on the second day after the operation and the diagnosis of infection within one month after the operation. We applied univariate, multivariate logistic regression, trend analysis, and subgroup analysis to find potential risk factors and the necessity of prophylactic antibiotics. Results. Among 142 eligible cases, 72 received antibiotics while 70 were kept as control, 113 cases were treated with c-TACE, and 29 were treated with DEB-TACE. Multivariate analysis showed that the increase in white blood cell count after the operation was related to diabetes (OR 5.112, 95% CI 1.229–21.264, p = 0.025). The occurrence of postoperative infection was negatively correlated with preoperative albumin value (＜25 g/L) (OR 153.118, 95% CI 1.631–14372.331, p = 0.030). Trend analysis showed that the risk of postoperative infection increased with a decrease in serum albumin level (P < 0.05). Subgroup analysis showed that there were no significant differences in the incidence of increased leukocyte count and postoperative infection between the prophylactic and nonprophylactic treatment groups, in the case of diabetes, preoperative albumin levels, and operation mode (P > 0.1). Conclusions. Prophylactic antibiotic treatment before the c-TACE or DEB-TACE had no significant correlation with postoperative leukocyte increase and postoperative infection. Diabetes history and serum albumin levels were the prominent risk factors associated with an increase in postoperative leukocyte count and postoperative infection. Future large-scale studies and randomized-controlled trials are required to confirm and validate this association.

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Section: Introductionmentioning

confidence: 99%

Prophylactic Use of Antibiotics for Postsurgical Infection in c-TACE and DEB-TACE High-Risk Patients: A Case-Control Study

2022

Journal of Healthcare Engineering

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“…prophylactically to all patients for its Grampositive coverage for skin commensals such as Staphylococcal and Streptococcal organisms to reduce post-procedural infections (11). No oral or intravenous antibiotics were prescribed postoperatively.…”

Section: Antibiotic Prophylaxis 2g Of Intravenous Cefazolin Was Givenmentioning

confidence: 99%

Effectiveness of integrated prophylactic antibiotics prescription in patients undergoing radiofrequency and microwave ablation of liver tumors: a retrospective cohort study

Pang,

Hung,

Chua

et al. 2024

TIJ

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An institutionalised in-house antibiotic prophylaxis (AP) guideline was developed in May 2019 to standardize AP prescription. This retrospective cohort study evaluated the effectiveness and clinical outcomes of the newly launched AP guideline on patients undergoing radiofrequency (RFA) and microwave (MWA) ablation of the liver from November 2018 to March 2020. Patients without high risk of biliary tree contamination were recommended a single dose of 2g IV cefazolin (or 600mg IV clindamycin in cases of beta-lactam allergy). Univariate analysis was conducted to evaluate the clinical outcomes. The study included 87 patients who underwent 93 procedures consisting of 18 RFAs and 75 MWAs for liver tumours. Concordance with AP guidelines improved significantly (38.5% vs. 87.0%; p<0.001). There were no ablation-related infections and mortality within 30 days post-ablation, and post-procedural nausea and vomiting were significantly reduced (15.4% vs. 1.9%; p=0.020). No significant difference in post-procedural fever (7.7% vs. 5.6%; p-value=0.693), chest and/or abdominal pain (5.1% vs. 7.4%; p=1.000) were noted. The newly implemented in-house antibiotic prophylaxis guideline streamlined AP prescribing in patients undergoing RFA and MWA. Additional research is needed to determine the effects on infection and mortality in patients with high-risk factors such as bile duct stents, sphincterotomies, and biliary-enteric anastomoses.

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“…Although small retrospective studies showed negative results, 26 , 27 a recent large-scale cohort with propensity score analysis demonstrated that prophylactic antibiotics reduced the occurrence of liver abscess following TACE by two-thirds. 28 …”

Section: Prophylactic Medications For Infection and Postembolization ...mentioning

confidence: 99%

Transarterial chemoembolization for hepatocellular carcinoma: 2023 expert consensus-based practical recommendations of the Korean Liver Cancer Association

Cho

Choi

Kwon

et al. 2023

JLC

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Transarterial chemoembolization (TACE) was introduced in 1977 with the administration of chemotherapeutic agent to gelatin sponge particles through the hepatic artery in patients with hepatocellular carcinoma (HCC) and was established as conventional TACE using Lipiodol in the 1980s. In the 2000s, drug-eluting beads were developed and applied clinically. Currently, TACE is a commonly used non-surgical treatment modality for patients with HCC who are unsuitable for curative treatment. Considering the vital role of TACE in the management of HCC, it is crucial to organize current knowledge and expert opinions regarding patient preparation, procedural techniques, and post-treatment care in TACE, which can enhance therapeutic efficacy and safety. A group of 12 experts in the fields of interventional radiology and hepatology, convened by the Research Committee of the Korean Liver Cancer Association (KLCA), has developed expert consensus-based practical recommendations in TACE. These recommendations have been endorsed by the Korean Society of Interventional Radiology and provide useful information and direction in performing TACE procedure as well as pre- and post- procedural patient care.

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Association between prophylactic antibiotic use for transarterial chemoembolization and occurrence of liver abscess: a retrospective cohort study

Cited by 9 publications

References 23 publications

Prophylactic Use of Antibiotics for Postsurgical Infection in c-TACE and DEB-TACE High-Risk Patients: A Case-Control Study

Prophylactic Use of Antibiotics for Postsurgical Infection in c-TACE and DEB-TACE High-Risk Patients: A Case-Control Study

Effectiveness of integrated prophylactic antibiotics prescription in patients undergoing radiofrequency and microwave ablation of liver tumors: a retrospective cohort study

Transarterial chemoembolization for hepatocellular carcinoma: 2023 expert consensus-based practical recommendations of the Korean Liver Cancer Association

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