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Infection Rates Following Hepatic Embolotherapy in Patients with Prior Biliary Interventions: Comparison of
Rupal S Parikh1, Omar Abousoud2, Stephen Hunt1
1Department of Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia.
Purpose:
To investigate the incidence of infection in patients with prior biliary interventions undergoing hepatic embolotherapy following extended antibiotic prophylaxis using moxifloxacin monotherapy or a multidrug regimen.
Material And Methods:
Under an Institutional Review Board-approved protocol, retrospective review of a quality assurance database identified all liver-directed therapies (LDTs) at a tertiary care center between 2010 and 2019 with biliary intervention prior to LDT Records were reviewed for infectious complications within 3 months of chemo- or radioembolization. Patients were categorized based on extended antibiotic prophylaxis regimen: oral moxifloxacin monotherapy or multidrug regimen of levofloxacin and metroniodazole plus preprocedural neomycin and erythromycin. Procedures without at least 2 months of clinical follow-up, hepatic ablation, and procedures without extended antibiotic prophylaxis were excluded Regression analysis was used to analyze multivariate data to detect a difference in infection rate.
Results:
Twenty-four chemoembolization and 58 radioembolization procedures were performed on 55 patients with prior biliary interventions. Forty-four used monotherapy and 38 used multidrug regimen. The incidence of infection was 16.7% (4/24) after chemoembolization and 13.8% (8/58) after radioembolization The incidence of infection in patients did not differ between antibiotic prophylaxis regimens (18.2% [8/44] with moxifloxacin monotherapy and 10.5% [4/38] multidrug regimen, P = .3) or between types of biliary interventions (24.1% [7/29] with bilioenteric anastomosis and 23.8% [5/21] biliary stenting, P = .3).
Conclusions:
The types of extended antibiotic prophylaxis (moxifloxacin monotherapy vs multitherapy), prior biliary intervention, and embolotherapy were not found to be associated with differences in the incidence of infectious complications in this population.
Insights
Extended antibiotic prophylaxis regimens did not impact infection rates in patients undergoing hepatic embolotherapy after biliary interventions. Both moxifloxacin monotherapy and multidrug regimens showed similar infectious complication rates.
Area of Science:
- Interventional Radiology
- Hepatobiliary Medicine
- Infectious Disease
Background:
- Patients with prior biliary interventions undergoing hepatic embolotherapy are at risk for infectious complications.
- Extended antibiotic prophylaxis is often used to mitigate these risks, but optimal regimens are debated.
Purpose of the Study:
- To investigate the incidence of infection in patients with prior biliary interventions who underwent hepatic embolotherapy.
- To compare infectious complication rates between extended antibiotic prophylaxis using moxifloxacin monotherapy versus a multidrug regimen.
Main Methods:
- Retrospective review of a quality assurance database for liver-directed therapies (LDTs) between 2010 and 2019.
- Infectious complications within 3 months of chemoembolization or radioembolization were analyzed.
- Patients were stratified by antibiotic prophylaxis: moxifloxacin monotherapy or a multidrug regimen (levofloxacin, metronidazole, neomycin, erythromycin).
Main Results:
- The overall incidence of infection was 16.7% after chemoembolization and 13.8% after radioembolization.
- No significant difference in infection rates was observed between moxifloxacin monotherapy (18.2%) and the multidrug regimen (10.5%) (P = .3).
- Infection rates were also similar between different types of prior biliary interventions (e.g., bilioenteric anastomosis vs. biliary stenting).
Conclusions:
- The type of extended antibiotic prophylaxis (moxifloxacin monotherapy vs. multidrug regimen) was not associated with differences in infectious complications.
- Prior biliary intervention and the type of embolotherapy did not significantly influence the incidence of infectious complications in this cohort.
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