2016, Number 5
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Ann Hepatol 2016; 15 (5)
Risk factors contributing to early infection following transjugular intrahepatic portosystemic shunt in perioperative period
Deng P, Zhou B, Li X
Language: English
References: 22
Page: 752-756
PDF size: 139.29 Kb.
ABSTRACT
Introducción and aim. To investigate and identify the risk factors associated with early infection following a transjugular intrahepatic
portosystemic shunt (TIPS)procedure in perioperative period.
Material and methods. The interventional radiology database
at the West China Hospital in Sichuan, China was reviewed to identify all patients that underwent a TIPS procedure between January
30, 2013 and August 30, 2015. Four hundred and sixty-six TIPS patients with liver cirrhosis were enrolled in this study. Liver
function was assessed using the Child-Pugh classification system and bacteremia was defined as patients that had a positive blood
culture. Statistical analysis was performed using χ
2 tests (include Fisher’s exact tests χ
2) and logistic regression analyses. A P‹
0.05 was set as the threshold for statistical significance.
Results. One hundred and forty-eight of the 466 (31.7%) patients developed
a fever. Eighty-three of the 148 fever patients subsequently had blood drawn for cultures and 9/83 (10.8%) patients developed
bacteremia as defined by a blood culture analysis. Cholangiolithiasis (P = 0.006), Child-Pugh class A designation (P = 0.001), Child-
Pugh class C designation (P = 0.005) and hepatitis C virus infection (P = 0.011) were significantly correlated with fever in these patients.
No statistically significant correlations were found between the other factors (age, gender, clinical manifestation, diabetes
mellitus, cholangiolithiasis, etc.) and bacteremia, with the exception of periprocedure cholangiolithiasis, which was significantly correlated
with blood culture-defined bacteremia (P ‹ 0.05).
Conclusions. Cholangiolithiasis is a risk factor for infection after a TIPS
procedure in the periprocedure period.
REFERENCES
Rösch J, Hanafee WN, Snow H. Transjugular portal venography and radiologic portacaval shunt: an experimental study. Radiology 1969; 92: 1112-4. [PMID: 5771827 DOI: 10.1148/92.5.1112].
Halpenny DF, Torreggiani WC. The infectious complications of interventional radiology based procedures in gastroenterology and hepatology. J Gastrointestin Liver Dis 2011; 20: 71-75 [PMID: 21451801].
Schiano TD, Atillasoy E, Fiel MI, Wolf DC, Jaffe D, Cooper JM, Jonas ME, et al. Fatal fungemia resulting from an infected transjugular intrahepatic portosystemic shunt stent. Am J Gastroenterol 1997; 92: 709-10 [PMID: 9128335 DOI:10.1097/01.rvi.0000153587.52276.06].
Borzio M, Salerno F, Piantoni L, Cazzaniga M, Angeli P, Bissoli F, Boccia S, et al. Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Dig Liver Dis 2001; 33: 41-48 [PMID: 11303974, DOI: 10.1016/s1590- 8658(01)80134-1].
Fernández J, Navasa M, Gómez J, Colmenero J, Vila J, Arroyo V, Rodés J. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology 2002; 35: 140-8 [PMID: 11786970 DOI: 10.1053/jhep.2002.30082].
Freedman AM, Sanyal AJ, Tisnado J, Cole PE, Shiffman ML, Luketic VA, Purdum PP, et al. Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review. Radiographics 1993; 13: 1185-1210 [PMID:8290720 DOI: 10.1148/radiographics.13.6.8290720].
DeSimone JA, Beavis KG, Eschelman DJ, Henning KJ. Sustained bacteremia associated with transjugular intrahepatic portosystemic shunt (TIPS). Clin Infect Dis 2000; 30: 384- 386 [PMID: 10671346 DOI: 10.1086/313653].
Cotran R, Kumar V, Collins T, Robbins S, Schmitt B. Robbins’ Pathologic Basis of Disease. 6th ed. Boston: WB Saunders; 1999, pp. 454-78.
Manolis EN, Filippou DK, Papadopoulos VP, Kaklamanos I, Katostaras T, Christianakis E, Bonatsos G, et al. The culture site of the gallbladder affects recovery of bacteria in symptomatic cholelithiasis. J Gastrointestin Liver Dis 2008; 17: 179-82 [PMID: 18568139].
Chang WT, Lee KT, Wang SR, Chuang SC, Kuo KK, Chen JS, Sheen PC. Bacteriology and antimicrobial susceptibility in biliary tract disease: an audit of 10-year’s experience. Kaohsiung J Med Sci 2002; 18: 221-8 [PMID: 12197428].
Swidsinski A, Lee SP. The role of bacteria in gallstone pathogenesis. Front Biosci 2001; 6: E93-103 [PMID: 11578976 DOI:10.2741/A699].
Kawai M, Iwahashi M, Uchiyama K, Ochiai M, Tanimura H, Yamaue H. Gram-positive cocci are associated with the formation of completely pure cholesterol stones. Am J Gastroenterol 2002; 97: 83-8 [PMID: 11808974 DOI: 10.1111/ j.1572-0241.2002.05425.x].
Al Harbi M, Osoba AO, Mowallad A, Al-Ahmadi K. Tract microflora in Saudi patients with cholelithiasis. Trop Med Int Health 2001; 6: 570-574 [PMID: 11469952 DOI: 10.1046/ j.1365-3156.2001.00748.x].
Csendes A, Mitru N, Maluenda F, Diaz JC, Burdiles P, Csendes P, Pinones E. Counts of bacteria and pyocites of choledochal bile in controls and in patients with gallstones or common bile duct stones with or without acute cholangitis. Hepatogastroenterology 1996; 43: 800-6 [PMID: 8884293 DOI: 10.1001/archsurg.1988.01400300039005].
Lötveit T, Osnes M, Aune S. Bacteriological studies of common duct bile in patients with gallstone disease and juxtapapillary duodenal diverticula. Scand J Gastroenterol 1978; 13: 93-95 [PMID: 416486 DOI: 10.3109/003655278091798 12].
Sanyal AJ, Reddy KR. Vegetative infection of transjugular intrahepatic portosystemic shunts. Gastroenterology 1998; 115: 110-115 [PMID:9649465, DOI: 10.1016/s0016-5085(98) 70371-3 ].
Gulberg V, Deibert P, Ochs A, Rossle M, Gerbes AL. Prevention of infectious complications after transjugular intrahepatic portosystemic shunt in cirrhotic patients with a single dose of ceftriaxone. Hepatogastroenterology 1999; 46: 1126-1130 [PMID: 10370679 DOI: 10.3748/wjg.v20.i33. 11835].
Ryan JM, Ryan BM, Smith TP. Antibiotic prophylaxis in interventional radiology. J VascInterv Radiol 2004; 15: 547-556 [PMID: 15178714 DOI: 10.1016/s1051-0443(99)71148-6].
Grill JP, Perrin S, Schneider F. Bile salt toxicity to some bifidobacteria strains: role of conjugated bile salt hydrolase and pH. Can J Microbiol 2000; 46: 878-884 [PMID: 11068673 DOI: 10.1139/cjm-46-10-878].
Cheng HY, Yang HY, Chou CC. Influence of acid adaptation on the tolerance of Escherichia coli O157: H7 to some subsequent stresses. J Food Prot 2002; 65: 260-5 [PMID: 11848555].
De Boever PW. Bile salt deconjugation by lactobacillus plantarum 80 and its implication for bacterial toxicity. J ApplMicrobiol 1999; 87: 345-352 [PMID: 10540235 DOI: 10.1046/j.1365-2672.1999.00019.x].
Kurtin WE, Enz J, Dunsmoor C, Evans N, Lightner DA. Acid dissociation constants of bilirubin and related carboxylic acid compounds in bile salt solutions. Arch Biochem Biophys 2000; 381: 83-91 [PMID: 11019823 DOI: 10.1006/ abbi.2000.1949].