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Enterococcal bacteremia after transjugular intrahepatic portosystemic shunts (TIPS)
R S Brown1, L Brumage, H F Yee
1Department of Medicine, University of North Carolina at Chapel Hill, 27599-7080, USA.
The American Journal of Gastroenterology
|May 12, 1998
Summary
Enterococcal bacteremia after transjugular intrahepatic portosystemic shunts (TIPS) is rare but deadly. Successful outcomes depend on prolonged antibiotics and repeat TIPS, not immediate liver transplantation.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Transplantation
Background:
- Transjugular intrahepatic portosystemic shunts (TIPS) are used to manage portal hypertension.
- Enterococcus faecium infections following TIPS are a rare but serious complication.
Observation:
- A case series of four patients with Enterococcus faecium bacteremia post-TIPS was analyzed.
- All patients presented with TIPS thrombosis; two survived after successful repeat TIPS and prolonged antibiotics.
Findings:
- Enterococcal bacteremia post-TIPS carries a high mortality rate, often linked to shunt thrombosis.
- Prolonged antibiotic therapy and successful reestablishment of portal decompression via repeat TIPS are crucial for survival.
- Liver transplantation is contraindicated during active infection.
Implications:
- Management strategies should prioritize long-term antibiotics and repeat TIPS procedures.
- Prophylaxis against Enterococcus may be considered for high-risk TIPS procedures.
- Further research is needed to optimize treatment and prevention for this rare complication.