title: Prolonged antibiotic prophylaxis in patients with bilioenteric anastomosis undergoing percutaneous radiofrequency ablation.
abstract: OBJECTIVE
  To reduce risk of development of a hepatic abscess in patients with preexisting bilioenteric anastomosis (BEA) undergoing radiofrequency (RF) ablation of hepatic tumors by use of prolonged antibiotic prophylaxis over at least 10 days.
  
  
  METHODS
  Between April 2003 and June 2011, 184 patients underwent 206 percutaneous RF ablation procedures for hepatic malignancies. Eight patients presented with BEA and were treated in 10 sessions at 14 tumor locations. These 8 patients were male and ranged in age from 55-73 years. Median follow-up was 34 months. Antibiotic prophylaxis was given before the intervention (n = 9, piperacillin/tazobactam; n = 1, ciprofloxacin). Oral antibiotic prophylaxis after the intervention was continued with ciprofloxacin for at least 10 days. In four cases, prophylaxis after the intervention was extended with additional antibiotics.
  
  
  RESULTS
  A liver abscess occurred 22 days after 1 of 10 RF ablation sessions in patients with preexisting BEA. The patient who developed an abscess presented with a large hepatocellular carcinoma (59 mm × 54 mm) and underwent transarterial chemoembolization 8 days before RF ablation. No hepatic abscess occurred after 196 RF ablation sessions in 176 patients without BEA.
  
  
  CONCLUSIONS
  Preexisting BEA is a risk factor for formation of hepatic abscesses after RF ablation. An antibiotic prophylaxis regimen before the intervention and for a prolonged period after the intervention that covers anaerobic bacteria for at least 10 days is presented. Combined therapy of transarterial chemoembolization and RF ablation increases the risk for complications in patients with known BEA.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Strasse 3, 72076 Tübingen. Ruediger.Hoffmann@med.uni-tuebingen.de
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Hoffmann
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Rempp
authors.forename: Diethard
authors.initials: D
authors.lastname: Schmidt
authors.forename: Philippe L
authors.initials: PL
authors.lastname: Pereira
authors.forename: Claus D
authors.initials: CD
authors.lastname: Claussen
authors.forename: Stephan
authors.initials: S
authors.lastname: Clasen
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000706:statistics & numerical data*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008100:Liver Abscess / Q000453:epidemiology* / Q000517:prevention & control*; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents