Ayhanım TÜMTÜRK, Cigdem ATAMAN HATİPOGLU

Endoscopic retrograde cholangiopancreatography sonrası gelişen bakteriyemide eşlik eden risk faktörleri

Amaç: Endoskopik retrograd kolanjiyopankreatografi (ERCP) sonrası bakteriyemi ciddi bir komplikasyondur, ancak bu komplikasyon için risk faktörleri henüz net olarak tanımlanmamıştır. Bu çalışmada ERCP sonrası bakteriyemi ve ilişkili risk faktörlerinin insidansını belirlemeyi amaçladık.Yöntemler: Bu retrospektif-kohort çalışma Ocak 2017-Aralık 2018 tarihleri arasında yapıldı. İşlem öncesi enfeksiyon belirtisi olmayan ve işlem sonrası bakteriyemi gelişen hastalar çalışmaya alındı. Bakteriyemi gelişen her hasta için ERCP uygulanan ve bakteriyemi geliştirmeyen iki randomize kontrol hastası risk faktörlerini, klinik ve laboratuvar bulgularını karşılaştırmak için seçildi.Bulgular: ERCP prosedürü uygulanan 4237 hastanın 86'sında toplam 91 bakteriyemi atağı tespit edildi. ERCP sonrası bakteriyemi oranı % 2 olarak bulundu. Çok değişkenli analizde, hastanın yaşı, safra yolları kanseri, kolesistit / kolanjit, pankreatit ve biyopsi bakteriyemi için anlamlı risk faktörleri olarak bulundu (sırasıyla P=0,009, P<0,001, P=0,008, P=0,002 ve P=0,014) .Sonuç: ERCP sonrası bakteriyemi gelişimi mortalite riskini önemli ölçüde artırmaktadır. Çalışmamızda, kaybedilen hastaların yaş ortalaması daha büyüktü. Bu sonuç, özellikle yaşlı hastalarda profilaktik antibiyotik kullanımını destekler niteliktedir. Potansiyel ERCP komplikasyonları ve risk faktörleri hakkındaki bilgi sahibi olmanın, komplikasyon insidansını ve şiddetini azaltmaya yardımcı olabileceğini düşünüyoruz.

Anahtar Kelimeler:

Endoscopic retrograde cholangiopancreatography, Bakteriyemi, Risk faktörleri

Risk factors for bacteremia following endoscopic retrograde cholangiopancreatography

Aim: Bacteremia after endoscopic retrograde cholangiopancreatography (ERCP) is a serious complication, but its risk factors have not yet been clearly defined. In this study, we aimed to determine the incidence of bacteremia and associated risk factors after ERCP.

Keywords:

Endoscopic retrograde cholangiopancreatography, Bacteremia, Risk factors,

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1. Ong TZ, Khor JL, Selamat DS, Yeoh KG, Ho KY. Complications of endoscopic retrograde cholangiography in the post-MRCP era: a tertiary center experience. World J Gastroenterol. 2005 Sep 7;11(33):5209-12.
2. Çalışkan YK, Kalaycı MU. Can failure of choledochal cannulation in endoscopic retrograde cholangiopancreatography be prevented? J Surg Med. 2018;2(3):253-6.
3. Kwak MS, Jang ES, Ryu JK, Kim YT, Yoon YB, Park JK. Risk factors of post endoscopic retrograde cholangiopancreatography bacteremia. Gut Liver. 2013 Mar;7(2):228-33.
4. Coelho-Prabhu N, Shah ND, Van Houten H, Kamath PS, Baron TH. Endoscopic retrograde cholangiopancreatography: utilisation and outcomes in a 10-year population-based cohort. BMJ Open. 2013 May 31;3(5).
5. Anderson DJ, Shimpi RA, McDonald JR, Branch MS, Kanafani ZA, Harger J, et al. Infectious complications following endoscopic retrograde cholangiopancreatography: an automated surveillance system for detecting postprocedure bacteremia. Am J Infect Control. 2008 Oct;36(8):592-4.
6. Du M, Suo J, Liu B, Xing Y, Chen L, Liu Y. Post-ERCP infection and its epidemiological and clinical characteristics in a large Chinese tertiary hospital: a 4-year surveillance study. Antimicrob Resist Infect Control. 2017 Dec 29;6:131.
7. Szary NM, Al-Kawas FH. Complications of endoscopic retrograde cholangiopancreatography: how to avoid and manage them. Gastroenterol Hepatol (N Y). 2013 Aug;9(8):496-504.
8. Pannu HK, Fishman EK. Complications of endoscopic retrograde cholangiopancreatography: spectrum of abnormalities demonstrated with CT. Radiographics. 2001 Nov-Dec;21(6):1441-53.
9. Anderson MA, Fisher L, Jain R, et al. ASGE Standards of Practice Committee. Guideline complications of ERCP. Gastrointest Endosc. 2012;75(3):467-73.
10. Jain PK, Vinay BN. Indications and complications of endoscopic retrograde cholangiopancreatography procedures in a tertiary care centre. Int J Adv Med. 2016 Nov;3(4):838-41.
11. Identifying Healthcare-associated Infections (HAI) for NHSN Surveillance. https://www.cdc.gov/nhsn/pdfs/pscmanual/2psc_identifyinghais_nhsncurrent.pdf. Accessed 30 Aug 2017.
12. Tarnasky PR, Kedia P. Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies. Gastrointest Interv. 2017;6:37–53.
13. Borges AC, Almeida PC, Furlani SMT, Cury MS, Pleskow DK. ERCP performance in a tertiary Brazilian Center: Focus on New Risk Factors, Complications and Quality Indicators. Arq Bras Cir Dig. 2018 Jun 21;31(1):e1348.
14. Tonolini M, Pagani A, Bianco R. Cross-sectional imaging of common and unusual complications after endoscopic retrograde cholangiopancreatography. Insights Imaging. 2015 Jun;6(3):323-38.
15. Novello P, Hagège H, Ducreux M, Buffet C, Choury A, Fritsch J, Liguory C, Jacques L, Etienne JP. Septicemias after endoscopic retrograde cholangiopancreatography. Risk factors and antibiotic prophylaxis. Gastroenterol Clin Biol. 1993;17(12):897-902.
16. Wobser H, Gunesch A, Klebl F.Prophylaxis of post-ERC infectious complications in patients with biliary obstruction by adding antimicrobial agents into ERC contrast media- a single center retrospective study. BMC Gastroenterol. 2017 Jan 13;17(1):10.
17. Juan J Vila, Everson LA Artifon, Jose Pinhata Otoch. Post-endoscopic retrograde cholangiopancreatography complications: How can they be avoided? World J Gastrointest Endosc. 2012 Jun 16;4(6):241–6.
18. Dutta SK, Cox M, Williams RB, Eisenstat TE, Standiford HC. Prospective evaluation of the risk of bacteremia and the role of antibiotics in ERCP. J Clin Gastroenterol. 1983 Aug;5(4):325-9.
19. Thosani N, Zubarik RS, Kochar R, Kothari S, Sardana N, Nguyen T, et al. Prospective evaluation of bacteremia rates and infectious complications among patients undergoing single-operator choledochoscopy during ERCP. Endoscopy. 2016 May;48(5):424-31.
20. Mollison LC, Desmond PV, Stockman KA, Andrew JH, Watson K, Shaw G, et al. A prospective study of septic complications of endoscopic retrograde cholangiopancreatography. J Gastroenterol Hepatol. 1994 Jan-Feb;9(1):55-9.
21. Devière J, Motte S, Dumonceau JM, Serruys E, Thys JP, Cremer M. Septicemia after endoscopic retrograde cholangiopancreatography. Endoscopy. 1990 Mar;22(2):72-5.
22. Motte S1, Deviere J, Dumonceau JM, Serruys E, Thys JP, Cremer M. Risk factors for septicemia following endoscopic biliary stenting. Gastroenterology. 1991 Nov;101(5):1374-81.
23. Rupp C, Bode K, Weiss KH, Rudolph G, Bergemann J, Kloeters-Plachky P, et al. Microbiological Assessment of Bile and Corresponding Antibiotic Treatment: A Strobe-Compliant Observational Study of 1401 Endoscopic Retrograde Cholangiographies. Medicine (Baltimore). 2016 Mar;95(10):e2390