title: Risk factors of post endoscopic retrograde cholangiopancreatography bacteremia.
abstract: OBJECTIVE
  Bacteremia following endoscopic retrograde cholangiopancreatography (ERCP) is a severe complication, but the risk factors for this condition have not yet been clearly determined. Thus, the aim of this study was to investigate the risk factors of post-ERCP bacteremia.
  
  
  METHODS
  Among patients who underwent ERCP from June 2006 to May 2009, we selected patients without any signs of infection prior to the ERCP procedures. Of these patients, we further selected those who experienced bacteremia after ERCP as well as two-fold age and sex-matched controls who did not experience bacteremia after ERCP procedures. We compared clinical, laboratory and technical aspects between these two groups.
  
  
  RESULTS
  There were 70 patients (3.1%) who developed bacteremia after ERCP. In the multivariate analysis, a history of previous liver transplantation, an elevated serum alkaline phosphatase level and an endoscopic retrograde biliary drainage procedure were independent risk factors of post-ERCP bacteremia (p=0.006, p=0.001, and p=0.004, respectively). The microbiologic analysis revealed the presence of gram-negative organisms in 80% of the cases, and 11 patients had infections with bacteria expressing extended spectrum β-lactamases. Pseudomonas infection was significantly more common in patients who received liver transplantation as compared to patients without transplantation (p=0.014).
  
  
  CONCLUSIONS
  A history of liver transplantation, elevated serum alkaline phosphatase levels and endoscopic retrograde biliary drainage procedure were independent risk factors of post-ERCP bacteremia and require additional attention in future studies.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. ; Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Min-Sun
authors.initials: MS
authors.lastname: Kwak
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Jang
authors.forename: Ji Kon
authors.initials: JK
authors.lastname: Ryu
authors.forename: Yong-Tae
authors.initials: YT
authors.lastname: Kim
authors.forename: Yong Bum
authors.initials: YB
authors.lastname: Yoon
authors.forename: Joo Kyung
authors.initials: JK
authors.lastname: Park
keywords: Alkaline phosphatase; Bacteremia; Endoscopic retrograde biliary drainage; Endoscopic retrograde cholangiopancreatography; Liver transplantation
references.citation: Transplant Proc. 2009 May;41(4):1319-21
references.pmid: 19460551
references.citation: J Dig Dis. 2010 Aug;11(4):237-43
references.pmid: 20649737
references.citation: N Engl J Med. 1994 Oct 27;331(17):1154-5
references.pmid: 7523947
references.citation: Gastrointest Endosc. 1994 Nov-Dec;40(6):716-21
references.pmid: 7859970
references.citation: Endoscopy. 1990 Mar;22(2):72-5
references.pmid: 2110524
references.citation: Dig Dis Sci. 1992 May;37(5):689-96
references.pmid: 1563308
references.citation: Postgrad Med J. 2007 Dec;83(986):773-6
references.pmid: 18057178
references.citation: Adv Chronic Kidney Dis. 2009 Jul;16(4):226-33
references.pmid: 19576552
references.citation: Am Surg. 1976 Apr;42(4):229-32
references.pmid: 1267273
references.citation: Gastrointest Endosc. 1992 Jul-Aug;38(4):444-9
references.pmid: 1511819
references.citation: HPB (Oxford). 2005;7(2):144-8
references.pmid: 18333179
references.citation: Am J Gastroenterol. 2001 Feb;96(2):417-23
references.pmid: 11232684
references.citation: Ann Surg. 1994 Jan;219(1):40-5
references.pmid: 8297175
references.citation: Endoscopy. 2005 Sep;37(9):857-63
references.pmid: 16116539
references.citation: Am J Infect Control. 2008 Oct;36(8):592-4
references.pmid: 18926314
references.citation: Transplantation. 2003 May 27;75(10):1659-63
references.pmid: 12777852
references.citation: N Engl J Med. 1996 Sep 26;335(13):909-18
references.pmid: 8782497
references.citation: Endoscopy. 1977 Nov;9(4):231-4
references.pmid: 412663
references.citation: Transpl Infect Dis. 2009 Feb;11(1):11-9
references.pmid: 18811632
references.citation: Gastrointest Endosc. 1998 Jul;48(1):1-10
references.pmid: 9684657
references.citation: Liver Transpl. 2010 Dec;16(12):1379-85
references.pmid: 21117247
references.citation: Gastroenterology. 1991 Nov;101(5):1374-81
references.pmid: 1936809
references.citation: Gastroenterology. 1976 Mar;70(3):314-20
references.pmid: 1248697
references.citation: BMJ. 2009 May 22;338:b1670
references.pmid: 19465469