Related Experiment Videos
Viridans streptococcal bacteremia after esophageal stricture dilation
G Zuccaro1, J E Richter, T W Rice
1Departments of Gastroenterology, Thoracic Surgery, Infectious Diseases and Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Gastrointestinal Endoscopy
|December 16, 1998
Summary
Esophageal stricture dilation frequently causes bacteremia (viridans streptococcus), persisting for minutes. Antibiotic prophylaxis is recommended for high-risk patients with valvular heart disease to prevent infective endocarditis.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Cardiology
Background:
- The risk of bacteremia following esophageal stricture dilation is not well-established.
- Physician consensus is lacking on antibiotic prophylaxis for patients with valvular heart disease undergoing dilation.
- This study aimed to quantify bacteremia incidence and duration post-dilation.
Purpose of the Study:
- To determine the frequency and duration of bacteremia after esophageal stricture dilation.
- To inform antibiotic prophylaxis guidelines for at-risk patients.
Main Methods:
- Blood cultures were drawn before and after dilation in patients without valvular heart disease.
- A control group underwent upper endoscopy without dilation.
- Cultures were analyzed at 1, 5, and 20-30 minutes post-procedure.
Main Results:
- 21% of patients undergoing dilation developed bacteremia (viridans streptococcus), versus 2% in controls (p=0.001).
- Bacteremia was detected in 23% at 1 minute, 17% at 5 minutes, and 5% at 20-30 minutes post-dilation.
- Bacteremia persisted for at least 5 minutes in 74% of positive cases.
Conclusions:
- Esophageal stricture dilation commonly leads to bacteremia.
- Bacteremia can persist for a clinically significant duration.
- Prophylactic antibiotics are supported for valvular heart disease patients undergoing dilation to prevent infective endocarditis.