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[Pseudomonas aeruginosa bacteremia as a complication after endoscopic retrograde cholangiopancreatography]
A Rodríguez Guardado1, J A Maradona, J A Cartón
1Unidad de Enfermedades Infecciosas (Servicio de Medicina Interna), Hospital Central de Asturias.
Background:
The present was performed to describe the characteristics of bacteremias by Pseudomonas aeruginosa following cholangiopancreatography and the methods of prevention and treatment of the same.
Methods:
Twelve different episodes of bacteremia by Pseudomonas aeruginosa were retrospectively studied in patients submitted to endoscopic cholangiopancreatography (ERCP) from 1993-1997.
Results:
Three point six percent of the patients undergoing ERCP presented episodes of bacteremias by the microorganism in the 48 hours following the procedure. Except for one case, the patients presented obstructive disease in the form of calculi or neoplasms at the level of the biliary tree. In three cases, sphincterotomy had been carried out which was followed by clinical manifestations of hemorrhage in one case. Three patients (25%) died as a consequence of bacteremia and a hepatic abscess was developed in one case. The bacteremia appeared in successive outbreaks from 1993-1997.
Conclusions:
Bacteremia by Pseudomonas aeruginosa following ERCP is more frequent in patients with obstructive disease of the biliary tract and has an important additional morbimortality. It is associated with incorrect endoscopic disinfection. The use of drugs with an antipseudomonal spectrum should be considered as preendoscopic prophylaxis.