Infectious complications of non-surgical biliary tract manipulation in paediatric patients. Role of antibiotic prophylaxis

Beatriz Soria-Navarro; Natalia Mendoza-Palomar; Javier Juampérez-Gomi; Susana Melendo; Maria Mercadal-Hally; Mayli Lung; María Mercedes Pérez; Jesús Quintero; Pere Soler-Palacin

doi:10.1016/j.eimc.2021.01.019

Infectious complications of non-surgical biliary tract manipulation in paediatric patients. Role of antibiotic prophylaxis

Enferm Infecc Microbiol Clin (Engl Ed). 2021 Mar 11:S0213-005X(21)00045-8. doi: 10.1016/j.eimc.2021.01.019. Online ahead of print.

[Article in English, Spanish]

Authors

Beatriz Soria-Navarro¹, Natalia Mendoza-Palomar², Javier Juampérez-Gomi³, Susana Melendo², Maria Mercadal-Hally³, Mayli Lung⁴, María Mercedes Pérez⁵, Jesús Quintero³, Pere Soler-Palacin⁶

Affiliations

¹ Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.
² Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Paediatric Antibiotic Stewarship Program (PROA-NEN), Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain.
³ Paediatric Hepatology and Liver Transplant Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain.
⁴ Microbiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Autonomous University of Barcelona (UAB), Barcelona, Catalonia, Spain.
⁵ Interventional Radiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain.
⁶ Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Paediatric Antibiotic Stewarship Program (PROA-NEN), Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain; Vall d'Hebron Barcelona Hospital Campus, Autonomous University of Barcelona (UAB), Barcelona, Catalonia, Spain. Electronic address: psoler@vhebron.net.

PMID: 33715879
DOI: 10.1016/j.eimc.2021.01.019

Abstract

Background: Infections related to non-surgical manipulation of the biliary tract (NSMBT) are common events despite periprocedural antibiotic prophylaxis (PAP). Since June 2017, our local protocol has indicated a 24-h regimen of intravenous piperacillin-tazobactam for this purpose.

Objective: We aimed to describe the incidence and characteristics of NSMBT-related paediatric infections, define risk factors for their development, and analyse adherence to our PAP protocol.

Materials and methods: Epidemiological, clinical, and microbiological data were collected in consecutive NSMBT procedures performed in paediatric patients (<18 years) in our centre (2010-2019).

Results: 113 procedures in 37 patients, median age 4 years (IQR 1-8), were included. Main underlying diseases were biliary atresia (32%) and cancer (14%). Sixty-eight percent had undergone liver transplant and 70% hepaticojejunostomy. In 44 procedures (39%), the intervention was performed during the course of infection and previously prescribed antibiotic treatment was maintained. In the other 69, PAP was specifically indicated for NSMBT; antibiotic adequacy increased from 35% to 100% after June 2017. In total, 32 NSMBT-related infections (28%) occurred, mainly in the first 24h post-procedure (72%); no deaths happened. Causative pathogens were Gram-negative rods (64%), Gram-positive cocci (28%), and Candida spp. (8%). Main related risk factors were hepaticojejunostomy, biliary obstruction, and liver transplant.

Conclusions: NSMBT in children entails a significant infection risk, even under antibiotic prophylaxis, being hepaticojejunostomy the main risk factor. Infectious complications mainly occurred immediately after the procedure. After establishing a PAP protocol, 100% of interventions received appropriate prophylaxis, decreasing antibiotic exposure time and potentially, the length of hospital stay.

Keywords: Antibiotic prophylaxis; Antimicrobial stewardship; Biliary tract; Cholangitis; Colangitis; Liver transplantation; Optimización antimicrobiana; Profilaxis antibiótica; Trasplante de hígado; Vías biliares.