BACKGROUND: Infection is a known complication of ERCP procedures, and the role of antibiotic prophylaxis is uncertain. OBJECTIVE: To document the incidence of infection after ERCP while changing the policy for antibiotic prophylaxis. DESIGN: Retrospective analysis of data collected prospectively on infection complications, with progressive reduction in the use of prophylactic antibiotics. SETTING: Single-center university referral hospital. PATIENTS: A total of 11,484 ERCP procedures were documented prospectively over a period of 11 years. INTERVENTIONS: After baseline assessment, the use of prophylactic antibiotics was sequentially reduced and simplified in 3 phases. MAIN OUTCOME MEASUREMENTS: Incidence of infection, categorized by severity. RESULTS: The infection rate was low overall and decreased significantly with time, from 0.48% to 0.25%, despite a marked reduction in the proportion of patients given antibiotics (from 95% to 25%). Multivariate analysis also showed that the only category of patients at increased risk for infection (despite antibiotics) was the subgroup undergoing interventions for biliary problems after liver transplantation. LIMITATIONS: A lack of routine follow-up may mean that some delayed infectious complications were not recorded. The low risk of infection in this series may reflect the high technical success rate for relief of biliary obstruction; thus, our current minimalist antibiotic policy may not be generalizable to community practice. CONCLUSIONS: Infectious complications of ERCP can be kept to a minimum with a limited use of prophylactic antibiotics.
BACKGROUND:Infection is a known complication of ERCP procedures, and the role of antibiotic prophylaxis is uncertain. OBJECTIVE: To document the incidence of infection after ERCP while changing the policy for antibiotic prophylaxis. DESIGN: Retrospective analysis of data collected prospectively on infection complications, with progressive reduction in the use of prophylactic antibiotics. SETTING: Single-center university referral hospital. PATIENTS: A total of 11,484 ERCP procedures were documented prospectively over a period of 11 years. INTERVENTIONS: After baseline assessment, the use of prophylactic antibiotics was sequentially reduced and simplified in 3 phases. MAIN OUTCOME MEASUREMENTS: Incidence of infection, categorized by severity. RESULTS: The infection rate was low overall and decreased significantly with time, from 0.48% to 0.25%, despite a marked reduction in the proportion of patients given antibiotics (from 95% to 25%). Multivariate analysis also showed that the only category of patients at increased risk for infection (despite antibiotics) was the subgroup undergoing interventions for biliary problems after liver transplantation. LIMITATIONS: A lack of routine follow-up may mean that some delayed infectious complications were not recorded. The low risk of infection in this series may reflect the high technical success rate for relief of biliary obstruction; thus, our current minimalist antibiotic policy may not be generalizable to community practice. CONCLUSIONS: Infectious complications of ERCP can be kept to a minimum with a limited use of prophylactic antibiotics.
Authors: Wafaa Ahmed; Dave Kyle; Amardeep Khanna; John Devlin; David Reffitt; Zeino Zeino; George Webster; Simon Phillpotts; Robert Gordon; Gareth Corbett; William Gelson; Manu Nayar; Haider Khan; Matthew Cramp; Jonathan Potts; Waleed Fateen; Hamish Miller; Bharat Paranandi; Matthew Huggett; Simon M Everett; Vinod S Hegade; Rebecca O'Kane; Ryan Scott; Neil McDougall; Phillip Harrison; Deepak Joshi Journal: Therap Adv Gastroenterol Date: 2022-09-26 Impact factor: 4.802