Bacteremia and "Endotipsitis" following transjugular intrahepatic portosystemic shunting
Open Access
- 1 January 2011
- journal article
- Published by Baishideng Publishing Group Inc. in World Journal of Hepatology
- Vol. 3 (5), 130-136
- https://doi.org/10.4254/wjh.v3.i5.130
Abstract
AIM: To identify all cases of bacteremia and suspected endotipsitis after Transjugular intrahepatic portosystemic shunting (TIPS) at our institution and to determine risk factors for their occurrence. METHODS: We retrospectively reviewed records of all patients who underwent TIPS in our institution between 1996 and 2009. Data included: indications for TIPS, underlying liver disease, demographics, positive blood cultures after TIPS, microbiological characteristics, treatment and outcome. RESULTS: 49 men and 47 women were included with a mean age of 55.8 years (range 15-84). Indications for TIPS included variceal bleeding, refractory ascites, hydrothorax and hepatorenal syndrome. Positive blood cultures after TIPS were found in 39/96 (40%) patients at various time intervals following the procedure. Seven patients had persistent bacteremia fitting the definition of endotipsitis. Staphylococcus species grew in 66% of the positive cultures, Candida and enterococci species in 15% each of the isolates, and 3% cultures grew other species. Multi-variate regression analysis identified 4 variables: hypothyroidism, HCV, prophylactic use of antibiotics and the procedure duration as independent risk factors for positive blood cultures following TIPS (P < 0.0006, 0.005, 0.001, 0.0003, respectively). Prophylactic use of antibiotics before the procedure was associated with a decreased risk for bacteremia, preventing mainly early infections, occurring within 120 d of the procedure. CONCLUSION: Bacteremia is common following TIPS. Risk factors associated with bacteremia include failure to use prophylactic antibiotics, hypothyroidism, HCV and a long procedure. Our results strongly support the use of prophylaxis as a means to decrease early post TIPS infections.Keywords
This publication has 49 references indexed in Scilit:
- Endotipsitis-persistent infection of transjugular intrahepatic portosystemic shunt: pathogenesis, clinical features and managementLiver International, 2010
- Hepatitis C Infection and the Risk of Bacteremia in Hemodialysis Patients with Tunneled Vascular Access CathetersSouthern Medical Journal, 2009
- Risk Factors for Febrile Morbidity after Abdominal Hysterectomy in a University Hospital in ThailandGynecologic and Obstetric Investigation, 2008
- Long‐term outcome of a covered vs. uncovered transjugular intrahepatic portosystemic shunt in Budd–Chiari syndromeLiver International, 2008
- Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndromeHepatology, 2004
- Natural history of decompensated hepatitis C virus-related cirrhosis. A study of 200 patientsJournal of Hepatology, 2004
- MELD and PELD: Application of survival models to liver allocationLiver Transplantation, 2001
- Long term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenal syndrome: a phase II studyGut, 2000
- A Comparison of Paracentesis and Transjugular Intrahepatic Portosystemic Shunting in Patients with AscitesNew England Journal of Medicine, 2000
- Sustained Bacteremia Associated with Transjugular Intrahepatic Portosystemic Shunt (TIPS)Clinical Infectious Diseases, 2000