3:27 PM Abstract No. 102 Infectious complications and postprocedural antibiotics following initial percutaneous biliary drainage for patients with endoscopically placed stents

Abstract

To evaluate the risk of cholangitis and role of postprocedural antibiotics for patients with endoscopic biliary stents (EBS) undergoing initial percutaneous biliary cholangiography and drainage (PTC). Retrospective review identified all adult patients undergoing initial PTC without preprocedural evidence of cholangitis over an 18-month period at a large academic center. Cholangitis was defined as fever ≥ 38.5°C within 24 hours of the PTC. Clinical characteristics between patients with and without EBS were compared using chi-squared. 64 patients with a mean age of 62 were included; all patients received preprocedural prophylactic antibiotics. 60 (94%) patients presented with biliary obstruction and 4 (6%) with biliary leak. 45 patients (70%) had a history of endoscopic retrograde cholangiopancreatography (ERCP), 23 (36%) had EBS, and 28 (44%) had a surgical bilioenteric anastomosis. Overall, 9 patients (14%) became cholangitic with one patient developing septic shock. Patients with EBS were more likely to develop cholangitis compared to both the entire cohort (7/23 vs. 2/41, P = 0.005) and patients with history of ERCP alone (7/23 vs. 1/19, P = 0.02). 22 (34.4%) patients were placed on postprocedural empiric antibiotics (i.e., antibiotics without clinical evidence of cholangitis) by their primary team. 6 patients with EBS were placed on empiric post procedure antibiotics and none developed cholangitis, whereas 7 of the 17 (41.2%) not placed on empiric antibiotics developed cholangitis (P = 0.059). These results suggest that patients with EBS may be at high-risk for developing cholangitis after initial PTC beyond the risk conferred to patients with previous ERCP. This may be due to the presence of an indwelling foreign body. The role of routine postprocedural empiric antibiotics for this patient group needs further investigation given the high morbidity associated with cholangitis.