REGULAR CONTENT
Final ID
489
Type
Original Scientific Research-Oral or Pos
Authors
O Abousoud1, S Hunt1, T Gade1, J Mondschein1, M Dagli1, D Sudheendra1, S Stavropoulos1, M Soulen1, G Nadolski1
Institutions
1Hospital of the University of Pennsylvania, Philadelphia, PA
Purpose
Patients with prior biliary interventions (bilioenteric anastomosis or stents) undergoing embolotherapy of liver tumors are at increased risk of hepatic abscess. This study investigates the risk of infection in this population following extended antibiotic prophylaxis using either moxifloxacin monotherapy or a multi-drug regimen (MDR).
Materials & Methods
Retrospective review of IR QA database identified all patients undergoing radioembolization (TARE) or lipiodol based chemoembolization (TACE) from 2010-16. Patient records were reviewed for history of prior biliary intervention and infectious complications within 3 months of embolization. Patients with prior biliary interventions were categorized by antibiotic prophylaxis regimen: oral moxifloxacin monotherapy 400mg daily 3 days prior to 17 days post-embolization or a multi-drug regimen (most often levofloxacin 500mg daily and metroniodazole 500mg twice daily 2 days prior to 14 days after plus oral neomycin 1g and erythromycin 1g orally 3 times the day before the procedure).
Results
In total, 881 patients underwent 1588 TACE procedures and 331 patients underwent 517 TARE procedures. 13 TACE and 49 TARE were performed in patients with prior biliary interventions. Among these 62 procedures, 20 used moxifloxacin and 40 used an MDR. Two patients were excluded because antibiotic regimen could not be confirmed. The incidence of infection was 0.2% (3/1575) post-TACE and 0.2% (1/468) post-Y90 in patients without prior biliary interventions compared to 15% (2/13) post-TACE and 4% (2/49) post-TARE in patients with prior biliary intervention (p= 0.0006 and p=0.025, respectively). The incidence of infection between patients with prior biliary interventions did not differ between antibiotic prophylaxis regimens (0/20 moxifloxacin and 4/40 MDR, p= 0.29), or between embolotherapies (2/49 TARE and 2/13 TACE, p= 0.2).
Conclusions
The incidence of infectious complications occurring after embolotherapy is significantly greater in patients with prior biliary interventions compared to those with intact biliary anatomy even with the use of extended antibiotic prophylaxis. The rate of infectious complications is similar for moxifloxacin monotherapy and a multidrug regimen.
Final ID
489
Type
Original Scientific Research-Oral or Pos
Authors
O Abousoud1, S Hunt1, T Gade1, J Mondschein1, M Dagli1, D Sudheendra1, S Stavropoulos1, M Soulen1, G Nadolski1
Institutions
1Hospital of the University of Pennsylvania, Philadelphia, PA
Purpose
Patients with prior biliary interventions (bilioenteric anastomosis or stents) undergoing embolotherapy of liver tumors are at increased risk of hepatic abscess. This study investigates the risk of infection in this population following extended antibiotic prophylaxis using either moxifloxacin monotherapy or a multi-drug regimen (MDR).
Materials & Methods
Retrospective review of IR QA database identified all patients undergoing radioembolization (TARE) or lipiodol based chemoembolization (TACE) from 2010-16. Patient records were reviewed for history of prior biliary intervention and infectious complications within 3 months of embolization. Patients with prior biliary interventions were categorized by antibiotic prophylaxis regimen: oral moxifloxacin monotherapy 400mg daily 3 days prior to 17 days post-embolization or a multi-drug regimen (most often levofloxacin 500mg daily and metroniodazole 500mg twice daily 2 days prior to 14 days after plus oral neomycin 1g and erythromycin 1g orally 3 times the day before the procedure).
Results
In total, 881 patients underwent 1588 TACE procedures and 331 patients underwent 517 TARE procedures. 13 TACE and 49 TARE were performed in patients with prior biliary interventions. Among these 62 procedures, 20 used moxifloxacin and 40 used an MDR. Two patients were excluded because antibiotic regimen could not be confirmed. The incidence of infection was 0.2% (3/1575) post-TACE and 0.2% (1/468) post-Y90 in patients without prior biliary interventions compared to 15% (2/13) post-TACE and 4% (2/49) post-TARE in patients with prior biliary intervention (p= 0.0006 and p=0.025, respectively). The incidence of infection between patients with prior biliary interventions did not differ between antibiotic prophylaxis regimens (0/20 moxifloxacin and 4/40 MDR, p= 0.29), or between embolotherapies (2/49 TARE and 2/13 TACE, p= 0.2).
Conclusions
The incidence of infectious complications occurring after embolotherapy is significantly greater in patients with prior biliary interventions compared to those with intact biliary anatomy even with the use of extended antibiotic prophylaxis. The rate of infectious complications is similar for moxifloxacin monotherapy and a multidrug regimen.