Biliary sepsis represents a major percentage of fatal complications after endoscopic
retrograde cholangiopancreatography. We performed a randomized controlled study to
investigate the value of antibiotic prophylaxis, and to assess the frequency and source
of infectious complications associated with ERCP. Ninety-six patients who underwent
100 endoscopic retrograde cholangiopancreatographics were included in the study. Half
of the patients received antibiotic prophylaxis (Cefotaxime 2 g i.v. 15 min before
the procedure). Bacteremia was detected in 2 % of the patients receiving antibiotic
prophylaxis, as compared with 16 %(p < 0.02) in the control group. In order to determine
the source of bacteremia, bile samples and irrigation fluid from the suction channel
of the endoscope were obtained for bacteriological evaluation. Several lines of evidence
suggested that bacteremia associated with ERCP was essentially caused by mucosal lesions
of the oropharynx. Bacteremia was asymptomatic, with the exception of two patients
who subsequently developed fever, but recovered rapidly under antibiotic therapy.
The frequency of cholangitis following ERCP was not significantly reduced by antibiotic
prophylaxis (4 % vs. 2 %). Recommendations for antibiotic prophylaxis are discussed.
Cholangiopancreatography, endoscopic retrograde - Bacterial infections, blood - Bacterial
infections, prevention and control - Cholangitis - Pancreatitis, etiology
