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Preventive Antibiotic Use and Complications After Endoscopic Retrograde Cholangiopancreatography in Patients
Fidelis E Uwumiro1, Solomon O Anighoro2, Michael M Bojerenu3
1Internal Medicine, Our Lady of Apostles Hospital, Akwanga, NGA.
Insights
Prophylactic antibiotics before ERCP in primary sclerosing cholangitis (PSC) patients significantly reduced pancreatitis risk but did not impact sepsis or cholangitis rates. Individualized antibiotic use is recommended.
Area of Science:
- Gastroenterology
- Hepatology
- Infectious Disease
Background:
- The American Society for Gastrointestinal Endoscopy recommends prophylactic antibiotics for ERCP in PSC patients.
- This study evaluates the impact of this recommendation on post-ERCP outcomes.
Purpose of the Study:
- To assess the effectiveness of prophylactic antibiotics in preventing post-ERCP complications in primary sclerosing cholangitis (PSC) patients.
- To analyze the association between antibiotic prophylaxis and the incidence of sepsis, acute cholangitis, and acute pancreatitis.
Main Methods:
- Analysis of Nationwide Inpatient Sample data from 2015-2021.
- Inclusion of adult hospitalizations for PSC undergoing ERCP, with and without antibiotic prophylaxis.
- Hierarchical multivariate logistic regression to determine the association between antibiotic use and post-ERCP complications.
Main Results:
- 32,972 hospitalizations were analyzed; 39.1% received antibiotic prophylaxis.
- Antibiotic prophylaxis was associated with a significant reduction in acute post-ERCP pancreatitis (aOR: 0.61).
- No significant difference was observed in the odds of post-ERCP septicemia (aOR: 0.85) or acute cholangitis (aOR: 0.87).
Conclusions:
- Prophylactic antibiotics in PSC patients undergoing ERCP significantly reduce the risk of pancreatitis.
- Antibiotic prophylaxis did not improve outcomes for post-ERCP sepsis or cholangitis.
- Individualized consideration of antibiotic prophylaxis is advised, balancing benefits against potential impacts on liver disease markers.
Background:
The American Society for Gastrointestinal Endoscopy recommends prophylactic antibiotics before endoscopic retrograde cholangiopancreatography (ERCP) in primary sclerosing cholangitis (PSC). We assessed the impact of this approach on the incidence of post-ERCP outcomes using nationwide data.
Methods:
Using 2015-2021 Nationwide Inpatient Sample data and relevant ICD-10 codes, we analyzed adult hospitalizations for PSC who underwent ERCP, with and without antibiotic prophylaxis. Hierarchical multivariate logistic regression analysis was used to assess the association between prophylactic antibiotic use and post-ERCP complications including sepsis, acute cholangitis, and acute pancreatitis.
Results:
We analyzed 32,972 hospitalizations for PSC involving ERCP, with 12,891 admissions (39.1%) receiving antibiotics before ERCP (cases) and 20,081 (60.9%) serving as controls. Cases were older than controls (mean age: 64.2 ± 8.6 vs. 61.3 ± 6.1 years; P = 0.020). Compared with controls, hospitalizations with antibiotic prophylaxis had a higher male population (7,541 (58.5%) vs. 11,265 (56.1%); P < 0.001) and higher comorbidity burden (Charlson comorbidity index score of ≥2: 5,867 (45.5%) of cases vs. 8,996 (44.8%) of controls; P = 0.01). Incidence of post-ERCP septicemia was 19.1% (6,275) with 2,935 incidences (22.8%) among cases compared with 3,340 (16.6%) among controls. Antibiotic prophylaxis did not significantly improve the odds of septicemia (aOR: 0.85; 95% CI: 0.77 - 1.09; P = 0.179). Approximately 2,271 (6.9%) cases of acute cholangitis and 5,625 (17.1%) cases of acute post-ERCP pancreatitis were recorded. After adjustments for multiple variables, no significant difference was observed in the odds of cholangitis (aOR: 0.87; 95% CI: 0.98 - 1.45; P = 0.08). However, antibiotic prophylaxis was correlated with a statistically significant reduction in the odds ratio of acute post-ERCP pancreatitis (aOR: 0.61; 95% CI: 0.57 - 0.66; P < 0.001).
Conclusion:
The use of antibiotic prophylaxis in hospitalizations with PSC was correlated with a significant reduction in the odds of post-ERCP pancreatitis. Antibiotic prophylaxis did not improve the odds of post-ERCP sepsis or cholangitis. Prophylactic use of antibiotics should be individualized, considering both their anti-infective benefits and potential impact on the biochemical markers of liver disease.
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