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Gastrointest Endosc. 2008 Mar;67(3):471-5. Epub 2007 Dec 3.

Infection after ERCP, and antibiotic prophylaxis: a sequential quality-improvement approach over 11 years.

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  • 1Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina 29425, USA.

Abstract

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.

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PMID:
18061594
[PubMed - indexed for MEDLINE]
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