Endotipsitis: an emerging prosthetic-related infection in patients with portal hypertension.
The transjugular intrahepatic portosystemic shunt (TIPS) is an option for the treatment of portal hypertension. However, TIPS infection (endotipsitis) is distinctly uncommon. We report 3 new patients and review 23 published cases of endotipsitis. We calculate an incidence of 1.33% in patients undergoing the procedure. Twenty-three cases (88%) occurred more than a month after the procedure. The most common presentation included fever and primary bacteremia or fungemia. Gram-positive (18 cases), gram-negative microorganisms (10 cases), and fungi (3 cases) were the etiologic agents. Diagnosis may be difficult to establish, and new diagnostic criteria have been proposed. Twenty patients responded well to antibiotic treatment, and the 6 remaining patients died because of the infection. Endotipsitis is a new infectious disease to be considered in patients with a TIPS and bloodstream infection that is not clearly attributable to another source. Prolonged courses of antimicrobial agents can be curative, but liver transplantation is also an option to consider.
Bouza
Emilio
E
Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain. ebouza@microb.net
Muñoz
Patricia
P
Rodríguez
Claudia
C
Grill
Fabio
F
Rodríguez-Créixems
Marta
M
Bañares
Rafael
R
Fernández
Javier
J
García-Pagán
Juan Carlos
JC
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents; D004359:Drug Therapy, Combination / Q000008:administration & dosage; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation / Q000706:statistics & numerical data*; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D018570:Risk Assessment; D017678:Sex Distribution; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents