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Infectious complications of non-surgical biliary tract manipulation in paediatric patients. Role of antibiotic
Beatriz Soria-Navarro1, Natalia Mendoza-Palomar2, Javier Juampérez-Gomi3
1Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.
Background:
Infections related to non-surgical manipulation of the biliary tract (NSMBT) are common events despite periprocedural antibiotic prophylaxis (PAP). Since June 2017, our local protocol has indicated a 24-h regimen of intravenous piperacillin-tazobactam for this purpose.
Objective:
We aimed to describe the incidence and characteristics of NSMBT-related paediatric infections, define risk factors for their development, and analyse adherence to our PAP protocol.
Materials And Methods:
Epidemiological, clinical, and microbiological data were collected in consecutive NSMBT procedures performed in paediatric patients (<18 years) in our centre (2010-2019).
Results:
113 procedures in 37 patients, median age 4 years (IQR 1-8), were included. Main underlying diseases were biliary atresia (32%) and cancer (14%). Sixty-eight percent had undergone liver transplant and 70% hepaticojejunostomy. In 44 procedures (39%), the intervention was performed during the course of infection and previously prescribed antibiotic treatment was maintained. In the other 69, PAP was specifically indicated for NSMBT; antibiotic adequacy increased from 35% to 100% after June 2017. In total, 32 NSMBT-related infections (28%) occurred, mainly in the first 24h post-procedure (72%); no deaths happened. Causative pathogens were Gram-negative rods (64%), Gram-positive cocci (28%), and Candida spp. (8%). Main related risk factors were hepaticojejunostomy, biliary obstruction, and liver transplant.
Conclusions:
NSMBT in children entails a significant infection risk, even under antibiotic prophylaxis, being hepaticojejunostomy the main risk factor. Infectious complications mainly occurred immediately after the procedure. After establishing a PAP protocol, 100% of interventions received appropriate prophylaxis, decreasing antibiotic exposure time and potentially, the length of hospital stay.
Insights
Non-surgical manipulation of the biliary tract (NSMBT) in children carries a significant infection risk. Implementing a standardized periprocedural antibiotic prophylaxis (PAP) protocol improved antibiotic adequacy and reduced exposure time.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Surgical Outcomes
Background:
- Infections following non-surgical manipulation of the biliary tract (NSMBT) are common despite antibiotic prophylaxis.
- A local protocol initiated in June 2017 mandates a 24-hour intravenous piperacillin-tazobactam regimen for NSMBT.
Purpose of the Study:
- To determine the incidence and characteristics of NSMBT-related pediatric infections.
- To identify risk factors associated with these infections.
- To evaluate adherence to the periprocedural antibiotic prophylaxis (PAP) protocol.
Main Methods:
- Retrospective analysis of epidemiological, clinical, and microbiological data.
- Inclusion of pediatric patients (<18 years) undergoing NSMBT between 2010-2019.
- Assessment of PAP protocol adherence and antibiotic adequacy.
Main Results:
- 32 infections (28%) occurred in 113 procedures, primarily within 24 hours post-procedure.
- Hepaticojejunostomy, biliary obstruction, and liver transplant were identified as key risk factors.
- Antibiotic adequacy for NSMBT prophylaxis increased from 35% to 100% after protocol implementation in June 2017.
Conclusions:
- NSMBT in children presents a substantial infection risk, with hepaticojejunostomy being the primary risk factor.
- Infectious complications typically manifest early post-procedure.
- The established PAP protocol ensures appropriate prophylaxis, potentially reducing antibiotic exposure and hospital stay.
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