Zusammenfassung
Bei endoskopischen Untersuchungen des Gastrointestinaltrakts kommt es häufig zu transienten Bakteriämien, allerdings nur sehr selten zu manifesten Infektionen. Trotzdem wird für ausgewählte Risikopatienten eine Antibiotikaprophylaxe empfohlen. Bei Patienten mit einem hohen Endokarditisrisiko (z. B. Klappenträger, Z.n. vorangegangener Endokarditis, angeborene zyanotische Vitien) sollte eine Antibiotikaprophylaxe mit Amoxicillin (Clindamycin oder Vancomycin bei Penicillinallergie) durchgeführt werden. Auch Patienten mit gestauten Gallengängen, bei denen eine endoskopische retrograde Cholangio-Pankreatikografie (ERCP) durchgeführt wird, sind, genauso wie Patienten vor der Anlage einer perkutanen endoskopischen Gastrostomie (PEG), Kandidaten für eine Antibiotikaprophylaxe. Patienten mit Leberzirrhose und endoskopischer Behandlung einer Ösophagusvarizenblutung benötigen ebenfalls eine antibiotische Therapie. In der Übersicht wird auch auf die Patienten, die keine Prophylaxe benötigen, eingegangen.
Summary
Transient bacteraemia during endoscopic examination of the gastrointestinal tract is well recognized, but infectious complications arising from such transient bacteraemia are rare. Nevertheless, patients at high risk should receive antibiotic prophylaxis. Patients with an increased risk for endocarditis (e. g. patients with a prosthetic heart valve or a history of endocarditis) should receive amoxicillin (clindamycin or vancomycin when allergic to penicillin) prophylactically. In addition, patients with cholestasis undergoing endoscopic retrograde cholangiopancreatography and those before percutaneous endoscopic gastrostomy should receive antibiotic prophylaxis. Patients with cirrhosis of the liver and endoscopic treatment of bleeding esophageal varices should be treated with antibiotics as well. Patients who do not need antibiotic prophylaxis will also be defined in this review.
Schlüsselwörter
Endoskopie - Endokarditis - Antibiotikaprophylaxe - Bakteriämie
Key words
Endoscopy - endocarditis - antibiotic prophylaxis - bakteraemia
Literatur
-
1 Levels of Evidence and Grades of Recommendation. Centre for Evidence-Based Medicine 2001
-
2
Adam D.
Revidierte Empfehlungen zur Prophylaxe der bakteriellen Endokarditis.
Chemotherapie J.
1999;
8
150-152
-
3
Baltch A L, Buhac I, Agrawal A, O’Connor P, Bram M, Malatino E.
Bacteremia after upper gastrointestinal endoscopy.
Arch Intern Med.
1977;
137
594-597
-
4
Barawi M, Gottlieb K, Cunha B, Portis M, Gress F.
A prospective evaluation of the incidence of bacteremia associated with EUS-guided fine-needle aspiration.
Gastrointest Endosc.
2001;
53
189-192
-
5
Bernard B, Grange J D, Khac E N, Amiot X, Opolon P, Poynard T.
Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis.
Hepatology.
1999;
29
1655-1661
-
6
Berner J S, Gaing A A, Sharma R, Almenoff P L, Muhlfelder T, Korsten M A.
Sequelae after esophageal variceal ligation and sclerotherapy: a prospective randomized study.
Am J Gastroenterol.
1994;
89
852-858
-
7
Blaise M, Pateron D, Trinchet J C, Levacher S, Beaugrand M, Pourriat J L.
Systemic antibiotic therapy prevents bacterial infection in cirrhotic patients with gastrointestinal hemorrhage.
Hepatology.
1994;
20
34-38
-
8
Botoman V A, Surawicz C M.
Bacteremia with gastrointestinal endoscopic procedures.
Gastrointest Endosc.
1986;
32
342-346
-
9
Brayko C M, Kozarek R A, Sanowski R A, Testa A W.
Bacteremia during esophageal variceal sclerotherapy: its cause and prevention.
Gastrointest Endosc.
1985;
31
10-12
-
10
Byl B, Deviere J, Struelens M J. et al .
Antibiotic prophylaxis for infectious complications after therapeutic endoscopic retrograde cholangiopancreatography: a randomized, double-blind, placebo-controlled study.
Clin Infect Dis.
1995;
20
1236-1240
-
11
Camara D S, Gruber M, Barde C J, Montes M, Caruana J A, Chung R S.
Transient bacteremia following endoscopic injection sclerotherapy of esophageal varices.
Arch Intern Med.
1983;
143
1350-1352
-
12
Cohen L B, Korsten M A, Scherl E J, Velez M E, Fisse R D, Arons E J.
Bacteremia after endoscopic injection sclerosis.
Gastrointest Endosc.
1983;
29
198-200
-
13
Collen M J, Hanan M R, Maher J A, Stubrin S E.
Modification of endoscopic retrograde cholangiopancreatography (ERCP) septic complications by the addition of an antibiotic to the contrast media. Randomized controlled investigation.
Am J Gastroenterol.
1980;
74
493-496
-
14
da Silveira Rohr M R, Siqueira E S, Brant C Q. et al .
Prospective study of bacteremia rate after elastic band ligation and sclerotherapy of esophageal varices in patients with hepatosplenic schistosomiasis.
Gastrointest Endosc.
1997;
46
321-323
-
15
Dajani A S, Taubert K A, Wilson W. et al .
Prevention of bacterial endocarditis. Recommendations by the American Heart Association.
Circulation.
1997;
96
358-366
-
16
de la Pena J, Rivero M, Sanchez E, Fabrega E, Crespo J, Pons-Romero F.
Variceal ligation compared with endoscopic sclerotherapy for variceal hemorrhage: prospective randomized trial.
Gastrointest Endosc.
1999;
49
417-423
-
17
Dormann A J, Wigginghaus B, Risius H. et al .
A single dose of ceftriaxone administered 30 minutes before percutaneous endoscopic gastrostomy significantly reduces local and systemic infective complications.
Am J Gastroenterol.
1999;
94
3220-3224
-
18
Goldman G D, Miller S A, Furman D S, Brock D, Ryan J L, McCallum R W.
Does bacteremia occur during flexible sigmoidoscopy?.
Am J Gastroenterol.
1985;
80
621-623
-
19
Gossner L, Keymling J, Hahn E G, Ell C.
Antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG): a prospective randomized clinical trial.
Endoscopy.
1999;
31
119-124
-
20
Harris A, Chan A C, Torres-Viera C, Hammett R, Carr-Locke D.
Meta-analysis of antibiotic prophylaxis in endoscopic retrograde cholangiopancreatography (ERCP).
Endoscopy.
1999;
31
718-724
-
21
Hirota W K, Petersen K, Baron T H. et al .
Guidelines for antibiotic prophylaxis for GI endoscopy.
Gastrointest Endosc.
2003;
58
475-482
-
22
Hirota W K, Wortmann G W, Maydonovitch C L. et al .
The effect of oral decontamination with clindamycin palmitate on the incidence of bacteremia after esophageal dilation: a prospective trial.
Gastrointest Endosc.
1999;
50
475-479
-
23
Ho H, Zuckerman M J, Wassem C.
A prospective controlled study of the risk of bacteremia in emergency sclerotherapy of esophageal varices.
Gastroenterology.
1991;
101
1642-1648
-
24
Hou M C, Lin H C, Liu T T. et al .
Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial.
Hepatology.
2004;
39
746-753
-
25
Jain N K, Larson D E, Schroeder K W. et al .
Antibiotic prophylaxis for percutaneous endoscopic gastrostomy. A prospective, randomized, double-blind clinical trial.
Ann Intern Med.
1987;
107
824-828
-
26
Jonas S K, Neimark S, Panwalker A P.
Effect of antibiotic prophylaxis in percutaneous endoscopic gastrostomy.
Am J Gastroenterol.
1985;
80
438-441
-
27
Kahaleh M, Shami V M, Conaway M R. et al .
Endoscopic ultrasound drainage of pancreatic pseudocyst: a prospective comparison with conventional endoscopic drainage.
Endoscopy.
2006;
38
355-359
-
28 Köhler B, Ginsbach C, Riemann J. Bacteremia after lasertherapy. Stuttgart: Georg Thieme Verlag In: Riemann J, Ell C, eds. Lasers in Gastroenterology 1989: 247-250
-
29
Lin O S, Wu S S, Chen Y Y, Soon M S.
Bacterial peritonitis after elective endoscopic variceal ligation: a prospective study.
Am J Gastroenterol.
2000;
95
214-217
-
30
Llach J, Elizalde J I, Bordas J M. et al .
Prospective assessment of the risk of bacteremia in cirrhotic patients undergoing lower intestinal endoscopy.
Gastrointest Endosc.
1999;
49
214-217
-
31
Lo G H, Lai K H, Cheng J S. et al .
A prospective, randomized trial of sclerotherapy versus ligation in the management of bleeding esophageal varices.
Hepatology.
1995;
22
466-471
-
32
Lo G H, Lai K H, Shen M T, Chang C F.
A comparison of the incidence of transient bacteremia and infectious sequelae after sclerotherapy and rubber band ligation of bleeding esophageal varices.
Gastrointest Endosc.
1994;
40
675-679
-
33
Lockhart P B.
An analysis of bacteremias during dental extractions. A double-blind, placebo-controlled study of chlorhexidine.
Arch Intern Med.
1996;
156
513-520
-
34
McGuire D, Brown R, Venu R, Etzkorn K, Abu-Hammour A.
Intraductal gentamicin during ERCP: does it prevent cholangitis?.
Gastrointest Endosc.
1995;
41
406A
-
35
Meyer G W.
Antibiotic prophylaxis for gastrointestinal procedures: who needs it?.
Gastrointest Endosc.
1994;
40
645-646
-
36
Meyer G W, Artis A L.
Antibiotic prophylaxis for orthopedic prostheses and GI procedures: report of a survey.
Am J Gastroenterol.
1997;
92
989-991
-
37
Mollison L C, Desmond P V, Stockman K A. et al .
A prospective study of septic complications of endoscopic retrograde cholangiopancreatography.
J Gastroenterol Hepatol.
1994;
9
55-59
-
38
Moore W S, Rosson C T, Hall A D.
Effect of prophylactic antibiotics in preventing bacteremic infection of vascular prostheses.
Surgery.
1971;
69
825-828
-
39
Motte S, Deviere J, Dumonceau J M, Serruys E, Thys J P, Cremer M.
Risk factors for septicemia following endoscopic biliary stenting.
Gastroenterology.
1991;
101
1374-1381
-
40
Nelson D B, Sanderson S J, Azar M M.
Bacteremia with esophageal dilation.
Gastrointest Endosc.
1998;
48
563-567
-
41
Niederau C, Pohlmann U, Lubke H, Thomas L.
Prophylactic antibiotic treatment in therapeutic or complicated diagnostic ERCP: results of a randomized controlled clinical study.
Gastrointest Endosc.
1994;
40
533-537
-
42
O’Connor H J, Hamilton I, Lincoln C, Maxwell S, Axon A T.
Bacteraemia with upper gastrointestinal endoscopy - a reappraisal.
Endoscopy.
1983;
15
21-23
-
43
Preclik G, Grune S, Leser H G. et al .
Prospective, randomised, double blind trial of prophylaxis with single dose of co-amoxiclav before percutaneous endoscopic gastrostomy.
BMJ.
1999;
319
881-884
-
44
Rey J R, Axon A, Budzynska A, Kruse A, Nowak A.
Guidelines of the European Society of Gastrointestinal Endoscopy (E.S.G.E.) antibiotic prophylaxis for gastrointestinal endoscopy. European Society of Gastrointestinal Endoscopy.
Endoscopy.
1998;
30
318-324
-
45
Sauter G, Grabein B, Huber G, Mannes G A, Ruckdeschel G, Sauerbruch T.
Antibiotic prophylaxis of infectious complications with endoscopic retrograde cholangiopancreatography. A randomized controlled study.
Endoscopy.
1990;
22
164-167
-
46
Schembre D, Bjorkman D J.
Post-sclerotherapy bacterial peritonitis.
Am J Gastroenterol.
1991;
86
481-486
-
47
Sharma V K, Howden C W.
Meta-analysis of randomized, controlled trials of antibiotic prophylaxis before percutaneous endoscopic gastrostomy.
Am J Gastroenterol.
2000;
95
3133-3136
-
48
Smith B C, Alqamish J R, Watson K J, Shaw R G, Andrew J H, Desmond P V.
Preventing endoscopic retrograde cholangiopancreatography related sepsis: a randomized controlled trial comparing two antibiotic regimes.
J Gastroenterol Hepatol.
1996;
11
938-941
-
49
Snady H, Korsten M A, Waye J D.
The relationship of bacteremia to the length of injection needle in endoscopic variceal sclerotherapy.
Gastrointest Endosc.
1985;
31
243-246
-
50
Soriano G, Guarner C, Tomas A. et al .
Norfloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage.
Gastroenterology.
1992;
103
1267-1272
-
51
Stephenson P M, Dorrington L, Harris O D, Rao A.
Bacteraemia following oesophageal dilatation and oesophago-gastroscopy.
Aust N Z J Med.
1977;
7
32-35
-
52
Stray N, Midtvedt T, Valnes K, Rosseland A, Pytte R, Hoivik B.
Endoscopy-related bacteremia.
Scand J Gastroenterol.
1978;
13
345-347
-
53
Sturgis T M, Yancy W, Cole J C, Proctor D D, Minhas B S, Marcuard S P.
Antibiotic prophylaxis in percutaneous endoscopic gastrostomy.
Am J Gastroenterol.
1996;
91
2301-2304
-
54
Tam F, Chow H, Prindiville T. et al .
Bacterial peritonitis following esophageal injection sclerotherapy for variceal hemorrhage.
Gastrointest Endosc.
1990;
36
131-133
-
55
Uno T, Munakata A.
Bacteremia after saline-assisted polypectomy.
Gastrointest Endosc.
1997;
46
279-281
-
56
van den Hazel S J, Speelman P, Dankert J, Huibregtse K, Tytgat G N, van Leeuwen D J.
Piperacillin to prevent cholangitis after endoscopic retrograde cholangiopancreatography. A randomized, controlled trial.
Ann Intern Med.
1996;
125
442-447
-
57
Welsh J D, Griffiths W J, McKee J, Wilkinson D, Flournoy D J, Mohr J A.
Bacteremia associated with esophageal dilatation.
J Clin Gastroenterol.
1983;
5
109-112
-
58
Wiersema M J, Vilmann P, Giovannini M, Chang K J, Wiersema L M.
Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment.
Gastroenterology.
1997;
112
1087-1095
-
59
Wolf D, Fleischer D, Sivak M V.
Incidence of bacteremia with elective upper gastrointestinal endoscopic laser therapy.
Gastrointest Endosc.
1985;
31
247-250
-
60
Yin T P, Dellipiani A W.
Bacterial endocarditis after Hurst bougienage in a patient with a benign oesophageal stricture.
Endoscopy.
1983;
15
27-28
-
61
Zuccaro G, Richter J E, Rice T W. et al .
Viridans streptococcal bacteremia after esophageal stricture dilation.
Gastrointest Endosc.
1998;
48
568-573
Dr. med. Dr. phil. Erwin Biecker
Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn
Sigmund-Freud-Straße 25
53105 Bonn
Telefon: 0228/2875507
Fax: 0228/2874322
eMail: erwin.biecker@ukb.uni-bonn.de
