Bacteraemia with upper gastrointestinal endoscopy--a reappraisal

Area of Science:

• Microbiology
• Infectious Diseases
• Gastroenterology

Background:

• Infective endocarditis is a serious infection of the heart lining or valves.
• Patients with prosthetic valves or a history of endocarditis are at higher risk.
• Upper gastrointestinal endoscopy is a common procedure with potential for bacteremia.

Purpose of the Study:

• To prospectively assess the risk of infective endocarditis in patients undergoing upper GI endoscopy.
• To determine the incidence, level, duration, and source of endoscopy-related bacteremia.
• To identify the microorganisms involved in procedure-related bacteremia.

Main Methods:

• Prospective study of 50 patients undergoing upper GI endoscopy.
• Blood samples drawn for aerobic and anaerobic cultures and pour plate estimation.
• Salivary cultures performed pre-endoscopy for comparison.

Main Results:

• Bacteremia occurred in 4% of patients (2 out of 50).
• Streptococci and other oropharyngeal organisms were isolated from blood cultures.
• Identical organisms were found in pre-endoscopy salivary cultures, indicating an oropharyngeal source.
• Pour plate estimations were negative, suggesting transient, low-level bacteremia.

Conclusions:

• The risk of infective endocarditis following upper GI endoscopy is likely very low.
• Transient, low-level bacteremia of oropharyngeal origin occurs in a small percentage of patients.
• Antibiotic prophylaxis is recommended for susceptible patients undergoing upper GI endoscopy.