Divyanshoo R Kohli1, Tilak U Shah2, Doumit S BouHaidar3, Ravi Vachhani3, M Shadab Siddiqui3. 1. Division of Gastroenterology & Hepatology, Virginia Commonwealth University, Richmond, VA, USA; Division of Gastroenterology & Hepatology, Mayo Clinic, Scottsdale, AZ, USA; Division of Gastroenterology & Hepatology, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA. Electronic address: kohli015@gmail.com. 2. Division of Gastroenterology & Hepatology, Virginia Commonwealth University, Richmond, VA, USA; Division of Gastroenterology & Hepatology, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA. 3. Division of Gastroenterology & Hepatology, Virginia Commonwealth University, Richmond, VA, USA.
Abstract
INTRODUCTION: Current practice guidelines recommend prophylactic antibiotics prior to endoscopic retrograde cholangiopancreatography (ERCP) in liver transplant recipients (LTR). This study evaluated the risk of clinically significant infections after ERCP in LTR who received antibiotic prophylaxis compared to those who did not. METHODS: This retrospective case-cohort study evaluated all LTR who underwent elective, outpatient ERCP from 2008 to 2015. Hospitalized patients, pediatric allograft recipients and patients with cholangitis or incomplete biliary drainage were excluded. The primary outcome was unanticipated hospitalization from procedure-related clinically significant infection occurring within 3 days of ERCP. RESULTS: Sixty-nine patients (48 males; mean age 60.5 ± 7.4 years) underwent 191 ERCPs after liver transplantation. Prophylactic antibiotics were administered during 82 ERCPs and not administered for 109 ERCPs. Unscheduled admissions for fever within 3 days occurred in 4 patients. Only 2 patients had documented bacteremia, of which only 1 patient received prophylactic antibiotics and also met primary outcome. Interventions during ERCP, patient demographics, and time from transplantation were not associated with increased risk of hospitalization from infections or bacteremia. CONCLUSIONS: The risk of infectious complications after ERCP in LTR is low and not affected by administration of prophylactic antibiotics. A tailored approach to antibiotic prophylaxis may be more appropriate than universal prophylaxis in selected LTR at low risk of infections.
INTRODUCTION: Current practice guidelines recommend prophylactic antibiotics prior to endoscopic retrograde cholangiopancreatography (ERCP) in liver transplant recipients (LTR). This study evaluated the risk of clinically significant infections after ERCP in LTR who received antibiotic prophylaxis compared to those who did not. METHODS: This retrospective case-cohort study evaluated all LTR who underwent elective, outpatient ERCP from 2008 to 2015. Hospitalized patients, pediatric allograft recipients and patients with cholangitis or incomplete biliary drainage were excluded. The primary outcome was unanticipated hospitalization from procedure-related clinically significant infection occurring within 3 days of ERCP. RESULTS: Sixty-nine patients (48 males; mean age 60.5 ± 7.4 years) underwent 191 ERCPs after liver transplantation. Prophylactic antibiotics were administered during 82 ERCPs and not administered for 109 ERCPs. Unscheduled admissions for fever within 3 days occurred in 4 patients. Only 2 patients had documented bacteremia, of which only 1 patient received prophylactic antibiotics and also met primary outcome. Interventions during ERCP, patient demographics, and time from transplantation were not associated with increased risk of hospitalization from infections or bacteremia. CONCLUSIONS: The risk of infectious complications after ERCP in LTR is low and not affected by administration of prophylactic antibiotics. A tailored approach to antibiotic prophylaxis may be more appropriate than universal prophylaxis in selected LTR at low risk of infections.
Authors: Matthew Fasullo; Priyanush Kandakatla; Reza Amerinasab; Divyanshoo Rai Kohli; Tilak Shah; Samarth Patel; Chandra Bhati; Doumit Bouhaidar; Mohammad S Siddiqui; Ravi Vachhani Journal: Ann Hepatobiliary Pancreat Surg Date: 2022-02-28
Authors: Divyanshoo R Kohli; M Edwyn Harrison; Abimbola O Adike; Bara El Kurdi; Norio Fukami; Douglas O Faigel; Rahul Pannala; Adyr A Moss; Bashar A Aqel Journal: Dig Dis Sci Date: 2019-01-02 Impact factor: 3.487