title: Bacteremia and "Endotipsitis" following transjugular intrahepatic portosystemic shunting.
abstract: OBJECTIVE
  To identify all cases of bacteremia and suspected endotipsitis after Transjugular intrahepatic portosystemic shunting (TIPS) at our institution and to determine risk factors for their occurrence.
  
  
  METHODS
  We retrospectively reviewed records of all patients who underwent TIPS in our institution between 1996 and 2009. Data included: indications for TIPS, underlying liver disease, demographics, positive blood cultures after TIPS, microbiological characteristics, treatment and outcome.
  
  
  RESULTS
  49 men and 47 women were included with a mean age of 55.8 years (range 15-84). Indications for TIPS included variceal bleeding, refractory ascites, hydrothorax and hepatorenal syndrome. Positive blood cultures after TIPS were found in 39/96 (40%) patients at various time intervals following the procedure. Seven patients had persistent bacteremia fitting the definition of endotipsitis. Staphylococcus species grew in 66% of the positive cultures, Candida and enterococci species in 15% each of the isolates, and 3% cultures grew other species. Multi-variate regression analysis identified 4 variables: hypothyroidism, HCV, prophylactic use of antibiotics and the procedure duration as independent risk factors for positive blood cultures following TIPS (P < 0.0006, 0.005, 0.001, 0.0003, respectively). Prophylactic use of antibiotics before the procedure was associated with a decreased risk for bacteremia, preventing mainly early infections, occurring within 120 d of the procedure.
  
  
  CONCLUSIONS
  Bacteremia is common following TIPS. Risk factors associated with bacteremia include failure to use prophylactic antibiotics, hypothyroidism, HCV and a long procedure. Our results strongly support the use of prophylaxis as a means to decrease early post TIPS infections.
authors: Liver Unit, Division of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
authors: Meir
authors: M
authors: Mizrahi
authors: Lilach
authors: L
authors: Roemi
authors: Daniel
authors: D
authors: Shouval
authors: Tomer
authors: T
authors: Adar
authors: Maya
authors: M
authors: Korem
authors: Alon
authors: A
authors: Moses
authors: Alan
authors: A
authors: Bloom
authors: Oren
authors: O
authors: Shibolet