Preventive Antibiotic Use and Complications After Endoscopic Retrograde Cholangiopancreatography in Patients Hospitalized for Primary Sclerosing Cholangitis
The American Society for Gastrointestinal Endoscopy recommends prophylactic antibiotics before endoscopic retrograde cholangiopancreatography (ERCP) in primary sclerosing cholangitis (PSC). We assessed the impact of this approach on the incidence of post-ERCP outcomes using nationwide data. Using 20...
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creator | Uwumiro, Fidelis E Anighoro, Solomon O Bojerenu, Michael M Akpabio, Nsikan N Asogwa, Samuel U Okpujie, Victory Alemenzohu, Hillary Ufuah, Osarumwense D Okoro, Miracle C Kanu, Ihunanya M Ayantoyinbo, Tosin Lawal, Ridwan A |
description | The American Society for Gastrointestinal Endoscopy recommends prophylactic antibiotics before endoscopic retrograde cholangiopancreatography (ERCP) in primary sclerosing cholangitis (PSC). We assessed the impact of this approach on the incidence of post-ERCP outcomes using nationwide data.
Using 2015-2021 Nationwide Inpatient Sample data and relevant ICD-10 codes, we analyzed adult hospitalizations for PSC who underwent ERCP, with and without antibiotic prophylaxis. Hierarchical multivariate logistic regression analysis was used to assess the association between prophylactic antibiotic use and post-ERCP complications including sepsis, acute cholangitis, and acute pancreatitis.
We analyzed 32,972 hospitalizations for PSC involving ERCP, with 12,891 admissions (39.1%) receiving antibiotics before ERCP (cases) and 20,081 (60.9%) serving as controls. Cases were older than controls (mean age: 64.2 ± 8.6 vs. 61.3 ± 6.1 years; P = 0.020). Compared with controls, hospitalizations with antibiotic prophylaxis had a higher male population (7,541 (58.5%) vs. 11,265 (56.1%); P < 0.001) and higher comorbidity burden (Charlson comorbidity index score of ≥2: 5,867 (45.5%) of cases vs. 8,996 (44.8%) of controls; P = 0.01). Incidence of post-ERCP septicemia was 19.1% (6,275) with 2,935 incidences (22.8%) among cases compared with 3,340 (16.6%) among controls. Antibiotic prophylaxis did not significantly improve the odds of septicemia (aOR: 0.85; 95% CI: 0.77 - 1.09; P = 0.179). Approximately 2,271 (6.9%) cases of acute cholangitis and 5,625 (17.1%) cases of acute post-ERCP pancreatitis were recorded. After adjustments for multiple variables, no significant difference was observed in the odds of cholangitis (aOR: 0.87; 95% CI: 0.98 - 1.45; P = 0.08). However, antibiotic prophylaxis was correlated with a statistically significant reduction in the odds ratio of acute post-ERCP pancreatitis (aOR: 0.61; 95% CI: 0.57 - 0.66; P < 0.001).
The use of antibiotic prophylaxis in hospitalizations with PSC was correlated with a significant reduction in the odds of post-ERCP pancreatitis. Antibiotic prophylaxis did not improve the odds of post-ERCP sepsis or cholangitis. Prophylactic use of antibiotics should be individualized, considering both their anti-infective benefits and potential impact on the biochemical markers of liver disease. |
doi_str_mv | 10.7759/cureus.64429 |
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Using 2015-2021 Nationwide Inpatient Sample data and relevant ICD-10 codes, we analyzed adult hospitalizations for PSC who underwent ERCP, with and without antibiotic prophylaxis. Hierarchical multivariate logistic regression analysis was used to assess the association between prophylactic antibiotic use and post-ERCP complications including sepsis, acute cholangitis, and acute pancreatitis.
We analyzed 32,972 hospitalizations for PSC involving ERCP, with 12,891 admissions (39.1%) receiving antibiotics before ERCP (cases) and 20,081 (60.9%) serving as controls. Cases were older than controls (mean age: 64.2 ± 8.6 vs. 61.3 ± 6.1 years; P = 0.020). Compared with controls, hospitalizations with antibiotic prophylaxis had a higher male population (7,541 (58.5%) vs. 11,265 (56.1%); P < 0.001) and higher comorbidity burden (Charlson comorbidity index score of ≥2: 5,867 (45.5%) of cases vs. 8,996 (44.8%) of controls; P = 0.01). Incidence of post-ERCP septicemia was 19.1% (6,275) with 2,935 incidences (22.8%) among cases compared with 3,340 (16.6%) among controls. Antibiotic prophylaxis did not significantly improve the odds of septicemia (aOR: 0.85; 95% CI: 0.77 - 1.09; P = 0.179). Approximately 2,271 (6.9%) cases of acute cholangitis and 5,625 (17.1%) cases of acute post-ERCP pancreatitis were recorded. After adjustments for multiple variables, no significant difference was observed in the odds of cholangitis (aOR: 0.87; 95% CI: 0.98 - 1.45; P = 0.08). However, antibiotic prophylaxis was correlated with a statistically significant reduction in the odds ratio of acute post-ERCP pancreatitis (aOR: 0.61; 95% CI: 0.57 - 0.66; P < 0.001).
The use of antibiotic prophylaxis in hospitalizations with PSC was correlated with a significant reduction in the odds of post-ERCP pancreatitis. Antibiotic prophylaxis did not improve the odds of post-ERCP sepsis or cholangitis. Prophylactic use of antibiotics should be individualized, considering both their anti-infective benefits and potential impact on the biochemical markers of liver disease.</description><identifier>ISSN: 2168-8184</identifier><identifier>EISSN: 2168-8184</identifier><identifier>DOI: 10.7759/cureus.64429</identifier><identifier>PMID: 39131042</identifier><language>eng</language><publisher>United States: Cureus Inc</publisher><subject>Antibiotics ; Cholangitis ; Codes ; Comorbidity ; Diagnosis related groups ; Disease prevention ; DRGs ; Endoscopy ; Frailty ; Gastroenterology ; Hospital costs ; Hospitalization ; Infections ; Infectious Disease ; Internal Medicine ; Liver ; Mortality ; Pancreatitis ; Patients ; Regression analysis ; Sepsis ; Sociodemographics</subject><ispartof>Curēus (Palo Alto, CA), 2024-07, Vol.16 (7), p.e64429</ispartof><rights>Copyright © 2024, Uwumiro et al.</rights><rights>Copyright © 2024, Uwumiro et al. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright © 2024, Uwumiro et al. 2024 Uwumiro et al.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c300t-f57ceb4c45aed85fc2c984657d7404763de459cbeab0b0475e48399cc52ae0723</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317107/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317107/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,882,27905,27906,53772,53774</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39131042$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Uwumiro, Fidelis E</creatorcontrib><creatorcontrib>Anighoro, Solomon O</creatorcontrib><creatorcontrib>Bojerenu, Michael M</creatorcontrib><creatorcontrib>Akpabio, Nsikan N</creatorcontrib><creatorcontrib>Asogwa, Samuel U</creatorcontrib><creatorcontrib>Okpujie, Victory</creatorcontrib><creatorcontrib>Alemenzohu, Hillary</creatorcontrib><creatorcontrib>Ufuah, Osarumwense D</creatorcontrib><creatorcontrib>Okoro, Miracle C</creatorcontrib><creatorcontrib>Kanu, Ihunanya M</creatorcontrib><creatorcontrib>Ayantoyinbo, Tosin</creatorcontrib><creatorcontrib>Lawal, Ridwan A</creatorcontrib><title>Preventive Antibiotic Use and Complications After Endoscopic Retrograde Cholangiopancreatography in Patients Hospitalized for Primary Sclerosing Cholangitis</title><title>Curēus (Palo Alto, CA)</title><addtitle>Cureus</addtitle><description>The American Society for Gastrointestinal Endoscopy recommends prophylactic antibiotics before endoscopic retrograde cholangiopancreatography (ERCP) in primary sclerosing cholangitis (PSC). We assessed the impact of this approach on the incidence of post-ERCP outcomes using nationwide data.
Using 2015-2021 Nationwide Inpatient Sample data and relevant ICD-10 codes, we analyzed adult hospitalizations for PSC who underwent ERCP, with and without antibiotic prophylaxis. Hierarchical multivariate logistic regression analysis was used to assess the association between prophylactic antibiotic use and post-ERCP complications including sepsis, acute cholangitis, and acute pancreatitis.
We analyzed 32,972 hospitalizations for PSC involving ERCP, with 12,891 admissions (39.1%) receiving antibiotics before ERCP (cases) and 20,081 (60.9%) serving as controls. Cases were older than controls (mean age: 64.2 ± 8.6 vs. 61.3 ± 6.1 years; P = 0.020). Compared with controls, hospitalizations with antibiotic prophylaxis had a higher male population (7,541 (58.5%) vs. 11,265 (56.1%); P < 0.001) and higher comorbidity burden (Charlson comorbidity index score of ≥2: 5,867 (45.5%) of cases vs. 8,996 (44.8%) of controls; P = 0.01). Incidence of post-ERCP septicemia was 19.1% (6,275) with 2,935 incidences (22.8%) among cases compared with 3,340 (16.6%) among controls. Antibiotic prophylaxis did not significantly improve the odds of septicemia (aOR: 0.85; 95% CI: 0.77 - 1.09; P = 0.179). Approximately 2,271 (6.9%) cases of acute cholangitis and 5,625 (17.1%) cases of acute post-ERCP pancreatitis were recorded. After adjustments for multiple variables, no significant difference was observed in the odds of cholangitis (aOR: 0.87; 95% CI: 0.98 - 1.45; P = 0.08). However, antibiotic prophylaxis was correlated with a statistically significant reduction in the odds ratio of acute post-ERCP pancreatitis (aOR: 0.61; 95% CI: 0.57 - 0.66; P < 0.001).
The use of antibiotic prophylaxis in hospitalizations with PSC was correlated with a significant reduction in the odds of post-ERCP pancreatitis. Antibiotic prophylaxis did not improve the odds of post-ERCP sepsis or cholangitis. Prophylactic use of antibiotics should be individualized, considering both their anti-infective benefits and potential impact on the biochemical markers of liver disease.</description><subject>Antibiotics</subject><subject>Cholangitis</subject><subject>Codes</subject><subject>Comorbidity</subject><subject>Diagnosis related groups</subject><subject>Disease prevention</subject><subject>DRGs</subject><subject>Endoscopy</subject><subject>Frailty</subject><subject>Gastroenterology</subject><subject>Hospital costs</subject><subject>Hospitalization</subject><subject>Infections</subject><subject>Infectious Disease</subject><subject>Internal Medicine</subject><subject>Liver</subject><subject>Mortality</subject><subject>Pancreatitis</subject><subject>Patients</subject><subject>Regression analysis</subject><subject>Sepsis</subject><subject>Sociodemographics</subject><issn>2168-8184</issn><issn>2168-8184</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkU9rGzEQxUVpaEKSW89F0EsPcaq_u6tTMSZtAoGatDkLrXbWVlhLW0lrSD9LP2zlOjFpTiNGPz3NvIfQe0ou61qqz3aKMKXLSgim3qATRqtm1tBGvH1xPkbnKT0QQiipGanJO3TMFeWUCHaC_iwjbMFntwU8L6V1ITuL7xNg4zu8CJtxcNZkF3zC8z5DxFe-C8mGsWB3kGNYRdMBXqzDYPzKhdF4G8HkXX9cP2Ln8bK8L38kfB3S6LIZ3G_ocB8iXka3MfER_7ADxJCcXx2Esktn6Kg3Q4Lzp3qK7r9e_Vxcz26_f7tZzG9nlhOSZ72sLbTCCmmga2RvmVWNqGTd1YKIuuIdCKlsC6YlbWlIEA1XylrJDBRP-Cn6stcdp3YDnS2zRjPocT-cDsbp_2-8W-tV2GpabKyLrUXh05NCDL8mSFlvXLIwlE0gTElzohihvGKkoB9foQ9hir7st6MUY0rIHXWxp2yxJUXoD9NQonfR6330-l_0Bf_wcoMD_Bw0_wvi9a_2</recordid><startdate>20240712</startdate><enddate>20240712</enddate><creator>Uwumiro, Fidelis E</creator><creator>Anighoro, Solomon O</creator><creator>Bojerenu, Michael M</creator><creator>Akpabio, Nsikan N</creator><creator>Asogwa, Samuel U</creator><creator>Okpujie, Victory</creator><creator>Alemenzohu, Hillary</creator><creator>Ufuah, Osarumwense D</creator><creator>Okoro, Miracle C</creator><creator>Kanu, Ihunanya M</creator><creator>Ayantoyinbo, Tosin</creator><creator>Lawal, Ridwan A</creator><general>Cureus Inc</general><general>Cureus</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20240712</creationdate><title>Preventive Antibiotic Use and Complications After Endoscopic Retrograde Cholangiopancreatography in Patients Hospitalized for Primary Sclerosing Cholangitis</title><author>Uwumiro, Fidelis E ; Anighoro, Solomon O ; Bojerenu, Michael M ; Akpabio, Nsikan N ; Asogwa, Samuel U ; Okpujie, Victory ; Alemenzohu, Hillary ; Ufuah, Osarumwense D ; Okoro, Miracle C ; Kanu, Ihunanya M ; Ayantoyinbo, Tosin ; Lawal, Ridwan A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c300t-f57ceb4c45aed85fc2c984657d7404763de459cbeab0b0475e48399cc52ae0723</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Antibiotics</topic><topic>Cholangitis</topic><topic>Codes</topic><topic>Comorbidity</topic><topic>Diagnosis related groups</topic><topic>Disease prevention</topic><topic>DRGs</topic><topic>Endoscopy</topic><topic>Frailty</topic><topic>Gastroenterology</topic><topic>Hospital costs</topic><topic>Hospitalization</topic><topic>Infections</topic><topic>Infectious Disease</topic><topic>Internal Medicine</topic><topic>Liver</topic><topic>Mortality</topic><topic>Pancreatitis</topic><topic>Patients</topic><topic>Regression analysis</topic><topic>Sepsis</topic><topic>Sociodemographics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Uwumiro, Fidelis E</creatorcontrib><creatorcontrib>Anighoro, Solomon O</creatorcontrib><creatorcontrib>Bojerenu, Michael M</creatorcontrib><creatorcontrib>Akpabio, Nsikan N</creatorcontrib><creatorcontrib>Asogwa, Samuel U</creatorcontrib><creatorcontrib>Okpujie, Victory</creatorcontrib><creatorcontrib>Alemenzohu, Hillary</creatorcontrib><creatorcontrib>Ufuah, Osarumwense D</creatorcontrib><creatorcontrib>Okoro, Miracle C</creatorcontrib><creatorcontrib>Kanu, Ihunanya M</creatorcontrib><creatorcontrib>Ayantoyinbo, Tosin</creatorcontrib><creatorcontrib>Lawal, Ridwan A</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Curēus (Palo Alto, CA)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Uwumiro, Fidelis E</au><au>Anighoro, Solomon O</au><au>Bojerenu, Michael M</au><au>Akpabio, Nsikan N</au><au>Asogwa, Samuel U</au><au>Okpujie, Victory</au><au>Alemenzohu, Hillary</au><au>Ufuah, Osarumwense D</au><au>Okoro, Miracle C</au><au>Kanu, Ihunanya M</au><au>Ayantoyinbo, Tosin</au><au>Lawal, Ridwan A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preventive Antibiotic Use and Complications After Endoscopic Retrograde Cholangiopancreatography in Patients Hospitalized for Primary Sclerosing Cholangitis</atitle><jtitle>Curēus (Palo Alto, CA)</jtitle><addtitle>Cureus</addtitle><date>2024-07-12</date><risdate>2024</risdate><volume>16</volume><issue>7</issue><spage>e64429</spage><pages>e64429-</pages><issn>2168-8184</issn><eissn>2168-8184</eissn><abstract>The American Society for Gastrointestinal Endoscopy recommends prophylactic antibiotics before endoscopic retrograde cholangiopancreatography (ERCP) in primary sclerosing cholangitis (PSC). We assessed the impact of this approach on the incidence of post-ERCP outcomes using nationwide data.
Using 2015-2021 Nationwide Inpatient Sample data and relevant ICD-10 codes, we analyzed adult hospitalizations for PSC who underwent ERCP, with and without antibiotic prophylaxis. Hierarchical multivariate logistic regression analysis was used to assess the association between prophylactic antibiotic use and post-ERCP complications including sepsis, acute cholangitis, and acute pancreatitis.
We analyzed 32,972 hospitalizations for PSC involving ERCP, with 12,891 admissions (39.1%) receiving antibiotics before ERCP (cases) and 20,081 (60.9%) serving as controls. Cases were older than controls (mean age: 64.2 ± 8.6 vs. 61.3 ± 6.1 years; P = 0.020). Compared with controls, hospitalizations with antibiotic prophylaxis had a higher male population (7,541 (58.5%) vs. 11,265 (56.1%); P < 0.001) and higher comorbidity burden (Charlson comorbidity index score of ≥2: 5,867 (45.5%) of cases vs. 8,996 (44.8%) of controls; P = 0.01). Incidence of post-ERCP septicemia was 19.1% (6,275) with 2,935 incidences (22.8%) among cases compared with 3,340 (16.6%) among controls. Antibiotic prophylaxis did not significantly improve the odds of septicemia (aOR: 0.85; 95% CI: 0.77 - 1.09; P = 0.179). Approximately 2,271 (6.9%) cases of acute cholangitis and 5,625 (17.1%) cases of acute post-ERCP pancreatitis were recorded. After adjustments for multiple variables, no significant difference was observed in the odds of cholangitis (aOR: 0.87; 95% CI: 0.98 - 1.45; P = 0.08). However, antibiotic prophylaxis was correlated with a statistically significant reduction in the odds ratio of acute post-ERCP pancreatitis (aOR: 0.61; 95% CI: 0.57 - 0.66; P < 0.001).
The use of antibiotic prophylaxis in hospitalizations with PSC was correlated with a significant reduction in the odds of post-ERCP pancreatitis. Antibiotic prophylaxis did not improve the odds of post-ERCP sepsis or cholangitis. Prophylactic use of antibiotics should be individualized, considering both their anti-infective benefits and potential impact on the biochemical markers of liver disease.</abstract><cop>United States</cop><pub>Cureus Inc</pub><pmid>39131042</pmid><doi>10.7759/cureus.64429</doi><oa>free_for_read</oa></addata></record> |
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subjects | Antibiotics Cholangitis Codes Comorbidity Diagnosis related groups Disease prevention DRGs Endoscopy Frailty Gastroenterology Hospital costs Hospitalization Infections Infectious Disease Internal Medicine Liver Mortality Pancreatitis Patients Regression analysis Sepsis Sociodemographics |
title | Preventive Antibiotic Use and Complications After Endoscopic Retrograde Cholangiopancreatography in Patients Hospitalized for Primary Sclerosing Cholangitis |
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