Role of ciprofloxacin in patients with cholestasis after endoscopic retrograde cholangiopancreatography

Ratanachu‐ek, Thawee; Prajanphanit, Pitchaya; Leelawat, Kawin; Chantawibul, Suchart; Panpimanmas, Sukij; Subwongcharoen, Somboon; Wannaprasert, Jerasak

doi:10.3748/wjg.v13.i2.276

Cited by 4 publications

(2 citation statements)

References 24 publications

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“…Prophylactic use of antibiotics as part of ERCP cannot reliably affect BB or cholangitis. Again, even biliary excreted Ciprofloxacin does not provide uniform protection against post-ERCP cholangitis[2].…”

Section: Discussionmentioning

confidence: 99%

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Bacterobilia in pancreatic surgery-conclusions for perioperative antibiotic prophylaxis

Krüger

Adam

Adam³

et al. 2019

WJG

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BACKGROUNDJaundice or preoperative cholestasis (PC) are typical symptoms of pancreatic masses. Approximately 50% of patients undergo preoperative biliary drainage (PBD) placement. PBD is a common cause of bacterobilia (BB) and is a known surgical site infection risk factor. An adjustment of preoperative antibiotic prophylaxis (PAP) may be reasonable according to the profile of BB. For this, we examined the microbiological findings in routine series of patients.AIMTo investigate the incidence and profile of biliary bacterial colonization in patients undergoing pancreatic head resections.METHODSIn the period from January 2009 to December 2015, 285 consecutive pancreatic head resections were performed. Indications for surgery were malignancy (71%), chronic pancreatitis (18%), and others (11%). A PBD was in 51% and PC was in 42%. The standard PAP was ampicillin/sulbactam. Intraoperatively, a smear was taken from the hepatic duct. An analysis of the isolated species and resistograms was performed. Patients were categorized according to the presence or absence of PC (PC+/PC-) and PBD (PBD+/PBD-) into four groups. Antibiotic efficiency was analyzed for standard PAP and possible alternatives.RESULTSBB was present in 150 patients (53%). BB was significantly more frequent in PBD+ (n =120) than in PBD- (n = 30), P < 0.01. BB was present both in patients with PC and without PC: (PBD-/PC-: 18%, PBD-/PC+: 30%, PBD+/PC-: 88%, PBD+/PC+: 80%). BB was more frequent in malignancy (56%) than in chronic pancreatitis (45%). PBD, however, was the only independent risk factor in multivariate analysis. In total, 357 pathogens (342 bacteria and 15 fungi) were detected. The five most common groups (n = 256, 74.8%) were Enterococcus spp. (28.4%), Streptococcus spp. (16.9%), Klebsiella spp. (12.6%), Escherichia coli (10.5%), and Enterobacter spp. (6.4%). A polymicrobial BB (PBD+: 77% vs PBD-: 40%, P < 0.01) and a more frequent detection of Enterococcus (P < 0.05) was significantly associated with PBD+. In PBD+, the efficiency of imipenem and piperacillin/tazobactam was significantly higher than that of the standard PAP (P < 0.01).CONCLUSIONPBD-/PC- and PBD-/PC+ were associated with a low rate of BB, while PBD+ was always associated with a high rate of BB. In PBD+ patients, BB was polymicrobial and more often associated with Enterococcus. In PBD+, the spectrum of potential bacteria may not be covered by standard PAP. A more potent alternative for prophylactic application, however, was not found.

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Section: Discussionmentioning

confidence: 99%

“…For example, an analysis of Medicare patients (1992-2007) showed that one in two patients already has a PBD at the time of the surgical consultation[1]. The disadvantage is that ERCP leads almost always to bacterobilia (BB)[2-4]. BB is a risk factor (up to factor 2) for surgical site infection[5-9].…”

Section: Introductionmentioning

confidence: 99%

Bacterobilia in pancreatic surgery-conclusions for perioperative antibiotic prophylaxis

Krüger

Adam

Adam³

et al. 2019

WJG

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Microbiology and Antibiotic Susceptibility of Organisms in Bile Cultures from Patients with and without Cholangitis at an Asian Academic Medical Center

Salvador¹,

Lozada²,

Consunji³

2011

Surgical Infections

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Gram-negative bacilli (or Enterobacteriaceae) (E. coli, K. pneumoniae, P. aeruginosa, and Enterobacter cloacae) were the most common aerobic microbial isolates in bile cultures from patients with cholangitis in the Philippines. Their antimicrobial susceptibility patterns suggest that imipenem-cilastatin (sensitivity 100%), meropenem (100%), amikacin (90-100%), cefepime (75%-100%), ceftriaxone (75%-100%), gentamicin (67%-100%), and piperacillin-tazobactam (50%-100%) would be the most effective antimicrobials for both groups. However, the authors echo the caution from the Surgical Infection Society/Infectious Diseases Society of America against using aminoglycosides as empiric drugs when safer and equally effective regimens are available.

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Clinical Effects of Bile Aspiration Just before Contrast Injection during Endoscopic Retrograde Cholangiopancreatography

Choi

Kang

Kim³

et al. 2012

Korean J Gastroenterol

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were analyzed. The incidence of post-ERCP cholangitis, liver function worsening, cholecystitis, pancreatitis, and hyperamylasemia only were compared between these two groups. Results: In the 102 patients with the bile aspiration group, post-ERCP cholangitis in 3 patients (2.9%), liver function worsening in 4 patients (3.9%), cholecystitis and pancreatitis in none, and hyperamylasemia only in 6 patients (5.8%) occurred. In the 115 patients with control group, post-ERCP cholangitis in 1 patient (0.4%), liver function worsening in 9 patients (7.8%), cholecystitis in none, pancreatitis in 3 patients (2.6%), hyperamylasemia only in 10 patients (8.6%) developed. The two groups did not significantly differ in terms of the incidence of post-ERCP cholangitis, liver function worsening, pancreatitis, and hyperamylasemia only (p>0.05). Conclusions: Initially bile juice aspiration just before contrast injection into the bile duct rarely prevented post-ERCP cholangitis, liver function worsening, and pancreatitis in patients with the extrahepatic bile duct obstruction. (Korean J Gastroenterol 2012;60:368-372)

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Role of ciprofloxacin in patients with cholestasis after endoscopic retrograde cholangiopancreatography

Cited by 4 publications

References 24 publications

Bacterobilia in pancreatic surgery-conclusions for perioperative antibiotic prophylaxis

Bacterobilia in pancreatic surgery-conclusions for perioperative antibiotic prophylaxis

Microbiology and Antibiotic Susceptibility of Organisms in Bile Cultures from Patients with and without Cholangitis at an Asian Academic Medical Center

Clinical Effects of Bile Aspiration Just before Contrast Injection during Endoscopic Retrograde Cholangiopancreatography

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