Sepsis associated with transhepatic cholangiography.

Area of Science:

• Interventional Radiology
• Infectious Disease Management
• Geriatric Medicine

Background:

• Obstructive jaundice in elderly patients often necessitates procedures like percutaneous transhepatic cholangiography (PTC) and percutaneous biliary drainage (PBD).
• These invasive procedures carry a risk of infectious complications, including fever and sepsis.

Purpose of the Study:

• To evaluate the impact of prophylactic antibiotics on the incidence of fever and sepsis following PTC and/or PBD in elderly patients.
• To assess the relationship between procedure type (PTC alone vs. PTC with PBD) and infectious complication rates.

Main Methods:

• Retrospective analysis of 74 elderly patients undergoing PTC and/or PBD.
• Data collection on patient demographics, underlying conditions (malignancy, choledocholithiasis), antibiotic prophylaxis, and infectious complications (fever, sepsis).
• Comparison of complication rates between patients who received prophylactic antibiotics and those who did not, and between PTC alone versus PTC with PBD.

Main Results:

• Overall sepsis incidence was 13.5%, with Enterobacter cloacae and Acinetobacter anitratus being common isolates in malignant obstruction.
• No significant difference in fever or sepsis rates between patients undergoing PTC alone versus those having both PTC and PBD.
• Two of 24 febrile patients died from sepsis, underscoring the severity of complications.

Conclusions:

• The study emphasizes the importance of antibiotic prophylaxis and prompt treatment for elderly patients undergoing percutaneous biliary interventions.
• Despite no observed difference in rates between procedure types in this cohort, the inherent risk of sepsis and mortality necessitates vigilance.
• Further research may be warranted to optimize antibiotic strategies in this vulnerable population.