title: Prospective evaluation of bacteremia rates and infectious complications among patients undergoing single-operator choledochoscopy during ERCP.
abstract: OBJECTIVE
  Choledochoscopy is increasingly performed during endoscopic retrograde cholangiopancreatography (ERCP) for direct bile duct visualization. Choledochoscopy necessitates irrigation of the bile duct with water or saline, which may increase intrabiliary pressure and consequently the risks of bacteremia and cholangitis. The aim of this study was to prospectively evaluate the risk of bacteremia and infectious complications in patients undergoing single-operator choledochoscopy (SOC).
  
  
  METHODS
  Patients requiring ERCP with SOC at two tertiary care centers were enrolled prospectively. Blood cultures were obtained immediately before the ERCP, after completion of the ERCP portion of the procedure (to determine ERCP-related bacteremia), and 15 minutes after completion of SOC.
  
  
  RESULTS
  A total of 72 patients (mean age 64 years; 51.4 % male) underwent ERCP with SOC. True positive blood cultures were noted in 20 patients (27.8 %; 95 % confidence interval [CI] 17.86 % - 39.59 %), of whom 6 patients (8.3 %; 95 %CI 3.12 % - 17.26 %) had transient bacteremia following ERCP. Of 14 patients (19.4 %; 95 %CI 11.05 % - 30.46 %) with sustained bacteremia following ERCP or SOC, 10 patients (13.9 %; 95 %CI 6.86 % - 24.06 %) had sustained bacteremia related to SOC. Despite the use of post-procedure intravenous antibiotic administration, seven patients (9.7 %; 95 %CI 3.99 - 19.01 %) required further antibiotic treatment for infectious complications, three of whom (4.2 %; 95 %CI 0.86 % - 11.69 %) were hospitalized in order to receive intravenous antibiotic therapy.
  
  
  CONCLUSIONS
  The bacteremia associated with ERCP with SOC and the subsequent risk of hospitalization for infectious complications suggest that preprocedure antibiotic prophylaxis should be considered for patients undergoing SOC, particularly in older patients and those with prior stent placement or undergoing intraductal stone lithotripsy.
  
  
  BACKGROUND
  clinical trials.gov (NCT01414400).
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University, Stanford, California, United States.
authors.forename: Nirav
authors.initials: N
authors.lastname: Thosani
authors.affiliation: Gastroenterology and Hepatology, University of Vermont Hospitals, Burlington, Vermont, United States.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Zubarik
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University, Stanford, California, United States.
authors.forename: Rajan
authors.initials: R
authors.lastname: Kochar
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University, Stanford, California, United States.
authors.forename: Shivangi
authors.initials: S
authors.lastname: Kothari
authors.affiliation: Gastroenterology and Hepatology, University of Vermont Hospitals, Burlington, Vermont, United States.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Sardana
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University, Stanford, California, United States.
authors.forename: Tu
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University, Stanford, California, United States.
authors.forename: Subhas
authors.initials: S
authors.lastname: Banerjee
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D016470:Bacteremia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D000071997:Blood Culture / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods; D002761:Cholangitis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D020379:Risk Adjustment / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents