1852. Recurrent Bacteremia after Endoscopic Injection of N-butyl-2-cyanoacrylate for Gastric Variceal Bleeding

Abstract

Abstract Background Gastric variceal bleeding is associated with a high mortality rate, and sclerotherapy using N-butyl-2-cyanoacrylate is the treatment of choice. The risk of recurrent bacteremia after N-butyl-2-cyanoacrylate injection has rarely been reported. We aimed to evaluate the frequency of this complication in a real-world setting. Methods We analyzed retrospective data from a single-center cohort of patients with liver cirrhosis who underwent N-butyl-2-cyanoacrylate injection for the treatment of bleeding gastric varices from January 2010 to March 2021. Recurrent bacteremia was defined as repeated bacteremia caused by the same microorganism after the resolution of the first event occurring at least two weeks from the date of the final positive blood culture of the first event. Results A total of 232 patients receiving 338 sessions of N-butyl-2-cyanoacrylate injection were enrolled. All patients received antibiotics prophylaxis; third-generation cephalosporins were used. The average age of patients was 59.5 ± 12.2 years and the mean Model for End-Stage Liver Disease (MELD) score was 14.8 ± 7.3. Of the patients following cyanoacrylate injection, 62 patients developed primary bacteremia at a median of 294 (range, 3−3710) days from N-butyl-2-cyanoacrylate injection. Nine out of 62 patients developed recurrent bacteremia following sclerotherapy with N-butyl-2-cyanoacrylate. The identified organisms were: Extended-Spectrum ß-Lactamase (ESBL)-producing Escherichia coli (3), ESBL-producing Klebsiella pneumoniae (2), non-ESBL-producing Klebsiella pneumoniae (2), Pseudomonas aeruginosa (1), and Methicillin-resistant Staphylococcus aureus (1). The median number of episodes of recurrent bacteremia per patient was 3 (range, 2−8) during the median 972 (range, 78−1997) days of follow-up. Four of these nine recurrent bacteremia patients died. Conclusion Recurrent bacteremia occurred in 3.9% of cirrhotic patients following cyanoacrylate injection for the treatment of gastric variceal bleeding. Foreign-body-type infection of the polymerized N-butyl-2-cyanoacrylate should be suspected in patients who had received previous endoscopic treatment with N-2-butyl-cyanoacrylate and fails to disclose another source of infection. Disclosures All Authors: No reported disclosures.