a prospective study of the risk of bacteremia in directed cholangioscopic examination of the common bile duct：一个导演的菌血症的胆总管胆道镜检查风险的前瞻性研究.pdfVIP

ORIGINAL ARTICLE A prospective study of the risk of bacteremia in directed cholangioscopic examination of the common bile duct Mohamed O. Othman, MD,1 Richard Guerrero, MD, MPH,2 Sherif Elhanafi, MD,2 Brian Davis, MD,2 Jesus Hernandez, MD, 2 Jennifer Houle, RN, 2 Indika Mallawaarachchi, MS,3 Alok Kumar Dwivedi, PhD,3 Marc J. Zuckerman, MD, FASGE, FACG2 Houston, El Paso, Texas, USA Background and Aims: The frequency of bacteremia during ERCP with cholangioscopy has not been well stud- ied. There are no formal guidelines regarding antibiotic prophylaxis before ERCP with cholangioscopy. The aim was to estimate the frequency of bacteremia and subsequent infectious adverse events after ERCP with cholangioscopy. Methods: This prospective nonrandomized study performed in a single tertiary referral center included adult pa- tients who were undergoing ERCP with cholangioscopic examination of the common bile duct. Blood cultures were drawn from patients before the procedure and 5 and 30 minutes after the procedure. Antibiotics were not given before or after the procedure. Patients were followed up after 24 hours and 1 week after the procedure for infectious adverse events. The primary outcome was bacteremia rate, and secondary outcomes were cholan- gitis rate and adverse events. Results: Fifty-seven patients were enrolled in the study with 60 procedures performed. The first procedure from each patient was considered in the analysis, and thus we included 57 patients with 57 procedures in this study anal- ysis. Postprocedure bacteremia was seen in 5 of 57 procedures (8.8%; 95% confidence interval, 2.9%-19.3%). Four patients were readmitted with cholangitis (7.0%). Bacteremia was more common in patients who had cholangio- scopy with b