Related Experiment Videos
Serious bacterial infections after endoscopic procedures
F Schlaeffer1, K Riesenberg, D Mikolich
1Department of Internal Medicine E, Soroka Medical Center and Ben Gurion University, Beer Sheva, Israel.
Abstract:
Transient bacteremia during and after endoscopic procedures is a well- documented phenomenon, but complicated bacteremia such as endocarditis in patients at risk is considered to be extremely rare. The recommendations for prophylaxis before endoscopy in patients with valvular heart disease were recently released. We discuss 16 cases of complicated bacteremia that developed after endoscopy (eight cases previously published in the literature and eight cases we encountered). The endoscopic procedures were gastroscopy (five cases), sclerotherapy (six cases), sigmoidoscopy (three cases), and esophageal dilation (two cases). Fourteen patients had underlying disease: valvular heart disease (six patients), cirrhosis of the liver (five patients, one of whom also had a prosthetic knee), valvular heart disease and cirrhosis of the liver (two patients), and gastric carcinoma (one patient). The organisms involved were Streptococcus viridans (six cases), streptococcus group D (three cases), Streptococcus pneumoniae (two cases), Streptococcus microaerophilicus (two cases), Staphylococcus aureus (two cases), and Cardiobacterium hominis (one case). The patients presented with the following infections: endocarditis (12 patients), spontaneous bacterial peritonitis (two patients), septic arthritis (one patient), and brain abscess (one patient). The outcome was good in 15 patients; one patient died. Patients with valvular heart disease, cirrhosis of the liver, ascites, malignancies, or prosthetic joints who undergo endoscopic procedures should be considered for antibiotic prophylaxis.
Insights
Complicated bacteremia after endoscopy, including endocarditis, is rare but serious in at-risk patients. Antibiotic prophylaxis may be beneficial for those with underlying conditions like heart disease or cirrhosis undergoing endoscopic procedures.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Cardiology
Background:
- Transient bacteremia is common after endoscopic procedures.
- Complicated bacteremia, such as endocarditis, is considered rare in at-risk populations.
- Recent guidelines address antibiotic prophylaxis for patients with valvular heart disease before endoscopy.
Purpose of the Study:
- To review cases of complicated bacteremia following endoscopic procedures.
- To identify risk factors and causative organisms.
- To inform prophylaxis recommendations for high-risk patients.
Main Methods:
- Retrospective review of 16 cases of complicated bacteremia post-endoscopy.
- Analysis of patient underlying conditions, endoscopic procedures, and microbial agents.
- Inclusion of 8 previously published cases and 8 newly encountered cases.
Main Results:
- Common procedures included gastroscopy, sclerotherapy, sigmoidoscopy, and esophageal dilation.
- Underlying conditions were valvular heart disease, liver cirrhosis, and gastric carcinoma.
- Infections included endocarditis (12 cases), spontaneous bacterial peritonitis, septic arthritis, and brain abscess.
Conclusions:
- Patients with valvular heart disease, liver cirrhosis, ascites, malignancies, or prosthetic joints undergoing endoscopy are at risk for complicated bacteremia.
- Antibiotic prophylaxis should be considered for these high-risk individuals.
- Prompt recognition and management are crucial, as most patients had favorable outcomes.