Prophylactic Antibiotic Guidelines in Modern Interventional Radiology Practice

Abstract

Modern interventional radiology practice is continuously evolving. Developments include increases in the number of central venous catheter placements and tumor treatments (uterine fibroid therapy, radio- and chemoembolization of liver tumor, percutaneous radiofrequency and cryoablation), and new procedures such as abdominal aortic aneurysm stent-graft repair, vertebroplasty, kyphoplasty, and varicose vein therapies. There have also been recent advancements in standard biliary and urinary drainage procedures, percutaneous gastrointestinal feeding tube placement, and transjugular intrahepatic portosystemic shunts. Prophylactic antibiotics have become the standard of care in many departments, with little clinical data to support its wide acceptance. The rise in antibiotic-resistant strains of organisms in all hospitals worldwide have forced every department to question the use of prophylactic antibiotics. The authors review the evidence behind use of prophylactic antibiotics in standard interventional radiology procedures, as well as in newer procedures that have only recently been incorporated into interventional radiology practice.

Percutaneous consolidation of loosened spine arthrodesis under CT and fluoroscopy guidance by radiologists: a new useful technique

“…No antibiotic coverage was used as there is not much data to support the routine use of antibiotic prophylaxis. [8] A CT centred on the treated segments was performed at the end of the intervention to confirm correct cement filling near the screws and to assess absence of complications (Fig. 5).…”

CT‐guided nephrostomy: Re‐inventing the wheel for the occasional interventionalist

“…Non-contrast CT imaging is performed for planning, and an intravenous dose of 2 mg/kg gentamicin (renal adjusted) administered as prophylaxis. 1 An axial oblique approach (Fig. 2b) to a lower pole calyx should be planned, as this will optimise possible exchange for an antegrade stent in the future.…”

Adult and Pediatric Antibiotic Prophylaxis during Vascular and IR Procedures: A Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology

“…The use of antibiotic prophylaxis continues to be debated (9). Historically, multidrug regimens have been associated with a decrease in the rate of hysterectomy-associated infections from 2% to 0.8%, but have been associated with an increase in vaginal discharge, likely from imbalances in vaginal flora (71).…”

“…Antibiotic prophylaxis for embolization of gastrointestinal bleeding is not necessary (17) except in cases of hemobilia in which accumulation of blood can lead to cholangitis (9). For splenic artery embolization, the risk of infection depends on the extent of ischemia created.…”

“…Unlike the incision site/wound infections incurred during surgery, the infectious complications in IR are most likely the result of bacterial inoculation into the bloodstream. Common mechanisms include (i) contamination of a needle, catheter, or wire by contact with a nonsterile surface or residual skin flora during vascular access (8); (ii) traversal of small vessels located along the trajectory of a needle creating channels of communication for bacteria to enter the bloodstream (9); (iii) intravasation of bacteria into the bloodstream from an obstructed viscus or abscess cavity (10); and (iv) proliferation of bacteria on the inside or outside of an indwelling catheter tract. Antibiotic prophylaxis for IR procedures therefore aims to clear bacterial contamination from the bloodstream to prevent a systemic inflammatory reaction (ie, sepsis) or the seeding of foreign material (eg, a stent) or necrotic tissue created during embolization or ablation.…”