Bloodstream infections after interventional procedures in the biliary tract

PURPOSE: To assess the adequacy of prophylaxis for interventional radiologic biliary procedures and the etiologic organisms of subsequent bloodstream infections. MATERIALS AND METHODS: Data from 148 patients who underwent 480 interventional radiologic biliary procedures were evaluated for evidence of bloodstream infection. Data analyzed included type of procedure performed, whether an antibiotic was used, and evidence of infectious complications occurring during and within 72 hours after the procedure. All culture data obtained before and after the procedure were recorded. RESULTS: Seven cases of new bloodstream infection were identified, five of which were caused by Enterococcus species. No substantial risk factors for bloodstream infection were identified, although it occurred only in patients who had recently undergone biliary surgery or underwent manipulations other than simple cholangiography. Microbial colonization of the bile was associated with older age. Evidence of possible or proved infection after the first interventional procedure was more common in patients with positive bile cultures. CONCLUSION: Although the importance of enterococcal bacteremia is uncertain, current recommendations for cephalosporin prophylaxis for interventional radiologic biliary procedures should be reevaluated.