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Abstract
Patient and procedural factors can increase the risk of infectious adverse events during endoscopy. Prophylactic antibiotic use must be judicious and individualized in the era of antibiotic resistance. New and emerging procedures require high-quality studies to elucidate appropriate risk profiles.
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Affiliation(s)
- Brian P H Chan
- Division of Gastroenterology, Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Tyler M Berzin
- Division of Gastroenterology, Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
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Goldis A, Goldis R, Chirila TV. Biomaterials in Gastroenterology: A Critical Overview. ACTA ACUST UNITED AC 2019; 55:medicina55110734. [PMID: 31726779 PMCID: PMC6915447 DOI: 10.3390/medicina55110734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/30/2019] [Accepted: 11/08/2019] [Indexed: 02/07/2023]
Abstract
In spite of the large diversity of diagnostic and interventional devices associated with gastrointestinal endoscopic procedures, there is little information on the impact of the biomaterials (metals, polymers) contained in these devices upon body tissues and, indirectly, upon the treatment outcomes. Other biomaterials for gastroenterology, such as adhesives and certain hemostatic agents, have been investigated to a greater extent, but the information is fragmentary. Much of this situation is due to the paucity of details disclosed by the manufacturers of the devices. Moreover, for most of the applications in the gastrointestinal (GI) tract, there are no studies available on the biocompatibility of the device materials when in intimate contact with mucosae and other components of the GI tract. We have summarized the current situation with a focus on aspects of biomaterials and biocompatibility related to the device materials and other agents, with an emphasis on the GI endoscopic procedures. Procedures and devices used for the control of bleeding, for polypectomy, in bariatrics, and for stenting are discussed, particularly dwelling upon the biomaterial-related features of each application. There are indications that research is progressing steadily in this field, and the establishment of the subdiscipline of "gastroenterologic biomaterials" is not merely a remote projection. Upon the completion of this article, the gastroenterologist should be able to understand the nature of biomaterials and to achieve a suitable and beneficial perception of their significance in gastroenterology. Likewise, the biomaterialist should become aware of the specific tasks that the biomaterials must fulfil when placed within the GI tract, and regard such applications as both a challenge and an incentive for progressing the research in this field.
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Affiliation(s)
- Adrian Goldis
- Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence:
| | | | - Traian V. Chirila
- Queensland Eye Institute, South Brisbane, QL 4101, Australia;
- Science & Engineering Faculty, Queensland University of Technology, Brisbane, QL 4000, Australia
- Faculty of Medicine, University of Queensland, Herston, QL 4029, Australia
- Australian Institute for Bioengineering and Nanotechnology, University of Queensland, St Lucia, 4072 QL, Australia
- Faculty of Science, University of Western Australia, Crawley, WA 6009, Australia
- University of Medicine, Pharmacy, Sciences and Technology, 540139 Targu Mures, Romania
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Infections in Liver Transplantation. PRINCIPLES AND PRACTICE OF TRANSPLANT INFECTIOUS DISEASES 2019. [PMCID: PMC7120017 DOI: 10.1007/978-1-4939-9034-4_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Liver transplantation has become an important treatment modality for patients with end-stage liver disease/cirrhosis, acute liver failure, and hepatocellular carcinoma. Although surgical techniques and immunosuppressive regimens for liver transplantation have improved significantly over the past 20 years, infectious complications continue to contribute to the morbidity and mortality in this patient population. The use of standardized screening protocols for both donors and recipients, coupled with targeted prophylaxis against specific pathogens, has helped to mitigate the risk of infection in liver transplant recipients. Patients with chronic liver disease and cirrhosis have immunological deficits that place them at increased risk for infection while awaiting liver transplantation. The patient undergoing liver transplantation is prone to develop healthcare-acquired infections due to multidrug-resistant organisms that could potentially affect patient outcomes after transplantation. The complex nature of liver transplant surgery that involves multiple vascular and hepatobiliary anastomoses further increases the risk of infection after liver transplantation. During the early post-transplantation period, healthcare-acquired bacterial and fungal infections are the most common types of infection encountered in liver transplant recipients. The period of maximal immunosuppression that occurs at 1–6 months after transplantation can be complicated by opportunistic infections due to both primary infection and reactivation of latent infection. Severe community-acquired infections can complicate the course of liver transplantation beyond 12 months after transplant surgery. This chapter provides an overview of liver transplantation including indications, donor-recipient selection criteria, surgical procedures, and immunosuppressive therapies. A focus on infections in patients with chronic liver disease/cirrhosis and an overview of the specific infectious complications in liver transplant recipients are presented.
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Maimone S, Saffioti F, Filomia R, Caccamo G, Saitta C, Pallio S, Consolo P, Sabatini S, Sitajolo K, Franzè MS, Cacciola I, Raimondo G, Squadrito G. Elective endoscopic variceal ligation is not a risk factor for bacterial infection in patients with liver cirrhosis. Dig Liver Dis 2018; 50:366-369. [PMID: 29317174 DOI: 10.1016/j.dld.2017.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/11/2017] [Accepted: 12/11/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with cirrhosis are at high risk of bacterial infections. Invasive procedures are generally believed to increase this susceptibility. AIMS We investigated the incidence of bacterial infections in cirrhotic patients undergoing elective endoscopic variceal ligation (EVL). METHODS We enrolled 60 consecutive cirrhotic patients who underwent a total number of 112 elective EVL procedures. One to seven bands were applied at each session until variceal eradication. Markers of inflammation/infection and blood cultures were obtained before and 24 h after EVL. RESULTS Aetiology of liver disease was metabolic in 27 (45%), viral in 21 (35%), alcoholic in 12 (20%) patients. Child-Pugh class A/B/C distribution was 29/26/5, respectively, 23 (38%) patients had ascites and 15 (25%) had hepatocellular carcinoma. Blood cultures were negative in all samples before EVL, whereas 3/112 (2.7%) cultures tested positive after endoscopy. Streptococcus mitis and Staphylococcus epidermidis were isolated in 1 and 2 cases, respectively. None of these three patients developed any features of clinically relevant infection, suggesting that the positive cultures were an expression of a transient bacteraemia with no clinical sequelae. CONCLUSIONS Bacterial infection is an uncommon occurrence after elective EVL in cirrhotic patients, and antibiotic prophylaxis is not necessary in this clinical setting.
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Affiliation(s)
- Sergio Maimone
- Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy.
| | - Francesca Saffioti
- Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Roberto Filomia
- Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gaia Caccamo
- Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy
| | - Carlo Saitta
- Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy
| | - Socrate Pallio
- Division of Digestive Endoscopy, University Hospital of Messina, Italy
| | - Pierluigi Consolo
- Division of Digestive Endoscopy, University Hospital of Messina, Italy
| | - Sara Sabatini
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Krizia Sitajolo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Stella Franzè
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Irene Cacciola
- Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Raimondo
- Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Squadrito
- Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy; Department of Human Pathology of the Adult and Evolutive Age, University of Messina, Messina, Italy
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Zuckerman MJ, Jia Y, Hernandez JA, Kolli VR, Norte A, Amin H, Casner NA, Dwivedi A, Ho H. A Prospective Randomized Study on the Risk of Bacteremia in Banding versus Sclerotherapy of Esophageal Varices. Front Med (Lausanne) 2016; 3:16. [PMID: 27200352 PMCID: PMC4852182 DOI: 10.3389/fmed.2016.00016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/11/2016] [Indexed: 01/22/2023] Open
Abstract
Background Esophageal variceal banding may be less likely to cause bacteremia than sclerotherapy. The existing data about the frequency of bacteremia after esophageal variceal banding are conflicting, and few studies include both banding and sclerotherapy. Aims We conducted a prospective randomized controlled trial to compare the frequency of bacteremia after esophageal variceal banding and sclerotherapy. Methods Over a 2-year period, patients with liver disease admitted for upper gastrointestinal bleeding or for outpatient elective variceal therapy were enrolled. New patients were randomized preprocedure to either banding or sclerotherapy, and subsequent sessions utilized the initial procedure. The groups consisted of banding, sclerotherapy, and endoscopy without variceal therapy. Subjects underwent endoscopy by one out of three gastroenterologists. Blood cultures were obtained 5 min before and 30 min after endoscopy to check for bacteremia. Results Postendoscopic blood cultures were positive following 4 out of 139 (2.9%) sessions: 1 sclerotherapy and 3 control sessions. All postendoscopic positive blood cultures were found following emergency sessions (4/92, 4.3%). One pre-endoscopic blood culture was positive in a patient with emergency banding. The rates of positive postendoscopic blood cultures among groups with emergency banding (0/22, 0%), emergency sclerotherapy (1/41, 2.3%), and emergency control (3/29, 10.3%) were not significantly different. Postendoscopic positive blood cultures were not found after elective sessions with either banding or sclerotherapy. Conclusions Postendoscopic bacteremia was infrequent following emergency endoscopy in patients with esophageal variceal bleeding. Bacteremia was not found after esophageal variceal banding, although this was not significantly less frequent than after sclerotherapy. Postendoscopic bacteremia was not associated with elective variceal therapy.
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Affiliation(s)
- Marc J Zuckerman
- Division of Gastroenterology, Texas Tech University Health Sciences Center , El Paso, Texas , USA
| | - Yi Jia
- Division of Gastroenterology, Texas Tech University Health Sciences Center , El Paso, Texas , USA
| | - Jesus A Hernandez
- Division of Gastroenterology, Texas Tech University Health Sciences Center , El Paso, Texas , USA
| | - Venkateswara R Kolli
- Division of Gastroenterology, Texas Tech University Health Sciences Center , El Paso, Texas , USA
| | - Arturo Norte
- Division of Gastroenterology, Texas Tech University Health Sciences Center , El Paso, Texas , USA
| | - Hemal Amin
- Division of Gastroenterology, Texas Tech University Health Sciences Center , El Paso, Texas , USA
| | - Nancy A Casner
- Division of Gastroenterology, Texas Tech University Health Sciences Center , El Paso, Texas , USA
| | - Alok Dwivedi
- Division of Biostatistics and Epidemiology, Texas Tech University Health Sciences Center , El Paso, Texas , USA
| | - Hoi Ho
- Division of Infectious Disease, Texas Tech University Health Sciences Center , El Paso, Texas , USA
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Jia Y, Dwivedi A, Elhanafi S, Ortiz A, Othman M, Zuckerman M. Low risk of bacteremia after endoscopic variceal therapy for esophageal varices: a systematic review and meta-analysis. Endosc Int Open 2015; 3:E409-17. [PMID: 26528494 PMCID: PMC4612236 DOI: 10.1055/s-0034-1392552] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 05/07/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Endoscopic variceal ligation (EVL) and endoscopic variceal sclerotherapy (EVS) are the main therapeutic procedures for the emergency treatment and secondary prophylaxis of esophageal varices in cirrhotics. Post-endoscopic bacteremia has been reported after EVS and EVL, but data on the frequency of bacteremia are conflicting. This study aims to provide incidences of bacteremia after EVS and EVL in different settings through meta-analysis. METHODS Only prospective or randomized studies were included in this meta-analysis. Binomial distribution was used to compute variance for each study. Random effects models were used as the final model for estimating the effect size and 95 % confidence interval. Adjusted effects were obtained using meta-regression analysis. RESULTS Nineteen prospective studies involving 1001 procedures in 587 patients were included in the meta-analysis on the risk of bacteremia after EVS or EVL in cirrhotics with esophageal varices. The frequency of bacteremia after endoscopic variceal therapy was 13 %. The frequency of bacteremia after EVS (17 %) was higher than after EVL (6 %) with no statistically significant difference (P = 0.106). The frequency of bacteremia after elective EVS (14 %) was significantly less than after emergency EVS (22 %) (P < 0.001). The frequency of bacteremia after elective EVL (7.6 %) was not significantly different from after emergency EVL (3.2 %) (P = 0.850). CONCLUSIONS The incidence of bacteremia is low in patients with cirrhosis and varices after esophageal variceal therapy. These results are consistent with our current guidelines that antibiotic prophylaxis before endoscopic variceal therapy is only necessary for bleeding patients.
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Affiliation(s)
- Yi Jia
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Alok Dwivedi
- Division of Biostatistics & Epidemiology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Sherif Elhanafi
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Arleen Ortiz
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Mohamed Othman
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Marc Zuckerman
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA,Corresponding author Marc J. Zuckerman, MD Division of GastroenterologyTexas Tech University Health Sciences Center4800 Alberta AvenueEl PasoTexas 79905USA+1-915-545-6634
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Bacteremia after Endoscopic Submucosal Excavation for Treating the Gastric Muscular Layer Tumors. Gastroenterol Res Pract 2015; 2015:306938. [PMID: 26060492 PMCID: PMC4427819 DOI: 10.1155/2015/306938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 03/23/2015] [Indexed: 12/16/2022] Open
Abstract
Background. The bacteremia is reported as being infrequent and transient in gastric EMR and ESD for treating gastric mucosa lesions or superficial gastric neoplastic lesion. There was no report of it being investigated in ESD for treating gastric muscular layer tumors (endoscopic submucosal excavation, ESE). This study aimed to determine the frequency of bacteremia in gastric ESE. Patients and Methods. A prospective study, in 122 consecutive patients who underwent gastric ESE for treating gastric muscular layer tumors, investigated the frequency of bacteremia before and 15 minutes after the procedure. Results. The median time for the total ESE procedure was 29 min (range from 8 to 62 min). The mean size of the biggest diameter of each resected specimen was 10 ± 2.7 mm (range from 5 mm to 30 mm). Blood cultures obtained before ESE were positive in 0% (0/122) of cases. Blood cultures obtained 15 min after ESE were positive in 2.5% (3/122) of cases. Six blood samples contained Staphylococcus with coagulase negative, which was considered contaminant. No signs of sepsis were seen in all patients. Conclusions. The frequency of bacteremia after gastric ESE was low. ESE for treating gastric lesions is thought to have a low risk of infectious complications; therefore, prophylactic administration of antibiotics may not be warranted.
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Chen CH, Wu SS, Huang CC. Two case reports of gastroendoscopy-associated Acinetobacter baumannii bacteremia. World J Gastroenterol 2013; 19:2835-40. [PMID: 23687423 PMCID: PMC3653160 DOI: 10.3748/wjg.v19.i18.2835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 03/11/2013] [Accepted: 03/13/2013] [Indexed: 02/06/2023] Open
Abstract
Two cases of gastroendoscopy-associated Acinetobacter baumannii (A. baumannii) bacteremia were discovered at the study hospital. The first case was a 66-year-old woman who underwent endoscopic retrograde cholangiopancreatography and endoscopic retrograde papillotomy, and then A. baumannii bacteremia occurred. The second case was a 70-year-old female who underwent endoscopic retrograde biliary drainage due to obstruction of intra-hepatic ducts, and bacteremia occurred due to polymicrobes (Escherichia coli, viridans streptococcus, and A. baumannii). After a literature review, we suggest that correct gastroendoscopy technique and skill in drainage procedures, as well as antibiotic prophylaxis, are of paramount importance in minimizing the risk of gastroendoscopy-associated bacteremia.
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Bonilha DQ, Correia LM, Monaghan M, Lenz L, Santos M, Libera ED. Prospective study of bacteremia rate after elective band ligation and sclerotherapy with cyanoacrylate for esophageal varices in patients with advanced liver disease. ARQUIVOS DE GASTROENTEROLOGIA 2011; 48:248-51. [DOI: 10.1590/s0004-28032011000400006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Accepted: 05/24/2011] [Indexed: 02/22/2023]
Abstract
CONTEXT: Band ligation (BL) is the most appropriate endoscopic treatment for acute bleeding or prophylaxis of esophageal variceal bleeding. Sclerotherapy with N-butyl-2-cyanoacrylate (CY) can be an alternative for patients with advanced liver disease. Bacteremia is an infrequent complication after BL while the bacteremia rate following treatment with CY for esophageal varices remains unknown. OBJECTIVES: To evaluate and compare the incidence of transient bacteremia between cirrhotic patients submitted to diagnostic endoscopy, CY and BL for treatment of esophageal varices. METHODS: A prospective study comprising the period from 2004 to 2007 was conducted at Hospital of Universidade Federal de São Paulo, UNIFESP, SP, Brazil. Cirrhotic patients with advanced liver disease (Child-Pugh B or C) were enrolled. The patients were divided into two groups according treatment: BL Group (patients undergoing band ligation, n = 20) and CY Group (patients receiving cyanoacrylate injection for esophageal variceal, n = 18). Cirrhotic patients with no esophageal varices or without indication for endoscopic treatment were recruited as control (diagnostic group n = 20). Bacteremia was evaluated by blood culture at baseline and 30 minutes after the procedure. RESULTS: After 137 scheduled endoscopic procedures, none of the 58 patients had fever or any sign suggestive of infection. All baseline cultures were negative. No positive cultures were observed after CY or in the control group - diagnostic endoscopy. Three (4.6 %) positive cultures were found out of the 65 sessions of band ligation (P = 0.187). Two of these samples were positive for coagulase-negative staphylococcus, which could be regarded as a contaminant. The isolated microorganism in the other case was Klebsiella oxytoca. The patient in this case presented no evidence of immunodeficiency except liver disease. CONCLUSIONS: There was no significant difference in bacteremia rate between these three groups. BL or CY injection for non-bleeding esophageal varices may be considered as low-risk procedures regarding bacteremia even when performed on patients with advanced liver disease.
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Affiliation(s)
| | | | | | - Luciano Lenz
- Universidade Federal de São Paulo, Brasil; Laboratório Fleury, Brasil
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Serafy ME, Mahmoud M, Gaber M. Pattern of bacteraemia following endoscopic elective oesophageal injection sclerotherapy and band ligation in cirrhotic patients. Arab J Gastroenterol 2010. [DOI: 10.1016/j.ajg.2010.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sass DA, Connelly SA, Ahmad J. Streptococcus salivarius bacteremia in a cirrhotic patient with neutropenia postesophageal variceal ligation. J Clin Gastroenterol 2006; 40:654-5. [PMID: 16917416 DOI: 10.1097/00004836-200608000-00023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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