Incidence of bacteremia in cirrhotic patients undergoing upper endoscopic ultrasonography.
BACKGROUND
The incidence of bacteremia after endoscopic ultrasonography (EUS) or EUS-guided fine-needle aspiration (EUS-FNA) is between 0% and 4%, but there are no data on this topic in cirrhotic patients.


OBJECTIVE
To prospectively assess the incidence of bacteremia in cirrhotic patients undergoing EUS and EUS-FNA.


METHODS
We enrolled 41 cirrhotic patients. Of these, 16 (39%) also underwent EUS-FNA. Blood cultures were obtained before and at 5 and 30 min after the procedure. When EUS-FNA was used, an extra blood culture was obtained after the conclusion of radial EUS and before the introduction of the sectorial echoendoscope. All patients were clinically followed up for 7 days for signs of infection.


RESULTS
Blood cultures were positive in 16 patients. In 10 patients, blood cultures grew coagulase-negative Staphylococcus, Corynebacterium species, Propionibacterium species or Acinetobacterium Lwoffii, which were considered contaminants (contamination rate 9.8%, 95% CI: 5.7-16%). The remaining 6 patients had true positive blood cultures and were considered to have had true bacteremia (15%, 95% CI: 4-26%). Blood cultures were positive after diagnostic EUS in five patients but were positive after EUS-FNA in only one patient. Thus, the frequency of bacteremia after EUS and EUS-FNA was 12% and 6%, respectively (95% CI: 2-22% and 0.2-30%, respectively). Only one of the patients who developed bacteremia after EUS had a self-limiting fever with no other signs of infection.


CONCLUSIONS
Asymptomatic Gram-positive bacteremia developed in cirrhotic patients after EUS and EUS-FNA at a rate higher than in non-cirrhotic patients. However, this finding was not associated with any clinically significant infections.
Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Spain.
Gloria
G
Fernández-Esparrach
Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Spain.
Oriol
O
Sendino
Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Spain.
Isis
I
Araujo
Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Spain.
Maria
M
Pellisé
Microbioloy Department, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Spain.
Manel
M
Almela
Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Spain.
Begoña
B
González-Suárez
Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Spain.
María
M
López-Cerón
Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Spain.
Henry
H
Córdova
Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Spain.
Erwin
E
Sanabria
Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Spain.
Hugo
H
Uchima
Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Spain.
Josep
J
Llach
Endoscopy Unit, Institut de Malalties Digestives i Metabòliques, Spain. Electronic address: magines@clinic.ub.es.
Àngels
À
Ginès
D000151:Acinetobacter Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D000368:Aged; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D044963:Biopsy, Fine-Needle / Q000009:adverse effects*; D001769:Blood / Q000382:microbiology; D019160:Endosonography / Q000009:adverse effects*; D004866:Equipment Contamination; D005189:False Positive Reactions; D005260:Female; D005334:Fever / Q000209:etiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
Antibiotics; Antibióticos; Bacteremia; Bacteriemia; Cirrhosis; Cirrosis; EUS-FNA; Endoscopic ultrasonography; Profilaxis; Prophylaxis; USE-PAAF; Ultrasonografía endoscópica