Antibiotic prophylaxis and its effect on postprocedural adverse events in endoscopic retrograde cholangiopancreatography for primary sclerosing cholangitis
Abstract Background and Aim Primary sclerosing cholangitis (PSC) is characterized by multiple strictures of the biliary tree. Patients with PSC frequently require repeated endoscopic retrograde cholangiopancreatography (ERCP) procedures. These procedures are encumbered by an increased incidence of i...
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| Format: | Article |
| Language: | English |
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Wiley
2023-01-01
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| Series: | JGH Open |
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| Online Access: | https://doi.org/10.1002/jgh3.12846 |
| _version_ | 1811177091154051072 |
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| author | Arvid Gustafsson Lars Enochsson Bobby Tingstedt Greger Olsson |
| author_facet | Arvid Gustafsson Lars Enochsson Bobby Tingstedt Greger Olsson |
| author_sort | Arvid Gustafsson |
| collection | DOAJ |
| description | Abstract Background and Aim Primary sclerosing cholangitis (PSC) is characterized by multiple strictures of the biliary tree. Patients with PSC frequently require repeated endoscopic retrograde cholangiopancreatography (ERCP) procedures. These procedures are encumbered by an increased incidence of infectious adverse events such as cholangitis. Evidence regarding whether antibiotic prophylaxis (AP) should be administered is sparse; however, prophylaxis is recommended. We aimed to determine whether AP affects the rate of postprocedural infectious and overall adverse events. Methods We conducted a retrospective cohort study and extracted all ERCP procedures with indicated PSC performed between 1 January 2006 and 31 December 2019, which were registered in the Swedish Registry for Gallstone Surgery and ERCP (GallRiks). The exclusion criteria were incomplete 30‐day follow‐up, non‐index procedures, or ongoing antibiotics. The main outcomes were postprocedural infectious adverse events and overall adverse events at the 30‐day follow‐up. Results A total of 2144 procedures with indication of PSC were eligible for inclusion. AP was administered in 1407 (66%) of these procedures. Patients receiving AP were slightly younger (44 vs 46 years, P = 0.005) and had more comorbidities (ASA ≥3, 19.8% vs 13.6%; P < 0.001). Procedures with AP demonstrated an infectious adverse event rate of 3.3% compared to 4.5% for non‐AP procedures (P = 0.19). Postprocedural infectious adverse events (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.48–1.21) and overall adverse events (OR 0.79, 95% CI 0.60–1.04) did not differ between AP and non‐AP. Conclusion Patients with PSC who undergo ERCP have the same frequency of adverse events regardless of whether AP was used. |
| first_indexed | 2024-04-10T22:56:14Z |
| format | Article |
| id | doaj.art-c6d2d38562f94d0daa158c9053dcac57 |
| institution | Directory Open Access Journal |
| issn | 2397-9070 |
| language | English |
| last_indexed | 2024-04-10T22:56:14Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | JGH Open |
| spelling | doaj.art-c6d2d38562f94d0daa158c9053dcac572023-01-14T11:33:20ZengWileyJGH Open2397-90702023-01-0171242910.1002/jgh3.12846Antibiotic prophylaxis and its effect on postprocedural adverse events in endoscopic retrograde cholangiopancreatography for primary sclerosing cholangitisArvid Gustafsson0Lars Enochsson1Bobby Tingstedt2Greger Olsson3Department of Research and Development and Department of Surgery Central Hospital Växjö SwedenDepartment of Surgical and Perioperative Sciences, Surgery Umeå University Umeå SwedenDepartment of Clinical Sciences Lund, Surgery, Lund University and Department of Surgery Skåne University Hospital Lund SwedenDepartment of Research and Development and Department of Surgery Central Hospital Växjö SwedenAbstract Background and Aim Primary sclerosing cholangitis (PSC) is characterized by multiple strictures of the biliary tree. Patients with PSC frequently require repeated endoscopic retrograde cholangiopancreatography (ERCP) procedures. These procedures are encumbered by an increased incidence of infectious adverse events such as cholangitis. Evidence regarding whether antibiotic prophylaxis (AP) should be administered is sparse; however, prophylaxis is recommended. We aimed to determine whether AP affects the rate of postprocedural infectious and overall adverse events. Methods We conducted a retrospective cohort study and extracted all ERCP procedures with indicated PSC performed between 1 January 2006 and 31 December 2019, which were registered in the Swedish Registry for Gallstone Surgery and ERCP (GallRiks). The exclusion criteria were incomplete 30‐day follow‐up, non‐index procedures, or ongoing antibiotics. The main outcomes were postprocedural infectious adverse events and overall adverse events at the 30‐day follow‐up. Results A total of 2144 procedures with indication of PSC were eligible for inclusion. AP was administered in 1407 (66%) of these procedures. Patients receiving AP were slightly younger (44 vs 46 years, P = 0.005) and had more comorbidities (ASA ≥3, 19.8% vs 13.6%; P < 0.001). Procedures with AP demonstrated an infectious adverse event rate of 3.3% compared to 4.5% for non‐AP procedures (P = 0.19). Postprocedural infectious adverse events (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.48–1.21) and overall adverse events (OR 0.79, 95% CI 0.60–1.04) did not differ between AP and non‐AP. Conclusion Patients with PSC who undergo ERCP have the same frequency of adverse events regardless of whether AP was used.https://doi.org/10.1002/jgh3.12846adverse eventsantibiotic prophylaxisendoscopic retrograde cholangiopancreatographyprimary sclerosing cholangitis |
| spellingShingle | Arvid Gustafsson Lars Enochsson Bobby Tingstedt Greger Olsson Antibiotic prophylaxis and its effect on postprocedural adverse events in endoscopic retrograde cholangiopancreatography for primary sclerosing cholangitis JGH Open adverse events antibiotic prophylaxis endoscopic retrograde cholangiopancreatography primary sclerosing cholangitis |
| title | Antibiotic prophylaxis and its effect on postprocedural adverse events in endoscopic retrograde cholangiopancreatography for primary sclerosing cholangitis |
| title_full | Antibiotic prophylaxis and its effect on postprocedural adverse events in endoscopic retrograde cholangiopancreatography for primary sclerosing cholangitis |
| title_fullStr | Antibiotic prophylaxis and its effect on postprocedural adverse events in endoscopic retrograde cholangiopancreatography for primary sclerosing cholangitis |
| title_full_unstemmed | Antibiotic prophylaxis and its effect on postprocedural adverse events in endoscopic retrograde cholangiopancreatography for primary sclerosing cholangitis |
| title_short | Antibiotic prophylaxis and its effect on postprocedural adverse events in endoscopic retrograde cholangiopancreatography for primary sclerosing cholangitis |
| title_sort | antibiotic prophylaxis and its effect on postprocedural adverse events in endoscopic retrograde cholangiopancreatography for primary sclerosing cholangitis |
| topic | adverse events antibiotic prophylaxis endoscopic retrograde cholangiopancreatography primary sclerosing cholangitis |
| url | https://doi.org/10.1002/jgh3.12846 |
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