Prospective assessment of the risk of bacteremia in cirrhotic patients undergoing lower intestinal endoscopy

• Published in: Gastrointestinal endoscopy 1999-02, Vol.49 (2), p.214-217
• Main Authors: Llach, Josep, Elizalde, J.Ignasi, Bordas, Josep M., Ginés, Angels, Almela, Manel, Sans, Miguel, Mondelo, Fernando, Piqué, Josep M.
• Format: Article
• Language: English
• Subjects: Bacteremia - epidemiology; Bacteremia - etiology; Biological and medical sciences; Colonoscopy - adverse effects; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Diseases - diagnosis; Humans; Incidence; Liver Cirrhosis - complications; Liver Cirrhosis - pathology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Monitoring, Physiologic; Other diseases. Semiology; Prospective Studies; Risk Assessment; Severity of Illness Index; Sigmoidoscopy - adverse effects; Spain - epidemiology; Staphylococcal Infections - epidemiology; Staphylococcal Infections - etiology
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(99)70489-X

Background: Patients who have prosthetic heart valves, previous history of endocarditis, and surgically constructed systemic-pulmonary shunts or conduits should receive prophylactic antibiotics before colonoscopy. The usefulness of this approach in cirrhotic patients remains unknown. The present study prospectively assesses the incidence of bacteremia in these patients. Methods: Lower intestinal endoscopy was performed in 58 cirrhotic patients. Two blood samples were obtained from every patient (just before endoscopy and within 5 minutes of withdrawal of the endoscope) and were incubated for 7 days and examined daily for growth of bacteria. Patients were closely monitored for 72 hours after endoscopy to detect the development of infectious complications. Results: Only 6 cultures from 6 patients were positive. Four were obtained post-endoscopy and the remaining 2 before colonoscopy but the corresponding post-endoscopy samples were negative. All organisms recovered were normal skin flora. All patients, including those with positive cultures, remained asymptomatic during the 72 hours after the procedure. Conclusions: Our findings indicate that lower intestinal endoscopy does not induce bacteremia in cirrhotic patients with or without ascites in the absence of gastrointestinal bleeding and do not support the routine use of prophylactic antibiotics in these patients. (Gastrointest Endosc 1999;49:214-7.)