Impact of eliminating postprocedural antibiotic prophylaxis in patients without biliary instrumentation or bypass undergoing hepatic artery embolization for hepatic malignancies Journal Article


Authors: Seo, S. K.; Gedrimaite, Z.; Fleischer, D.; Cohen, N.; Petre, E.; Brown, K. T.; Covey, A.
Article Title: Impact of eliminating postprocedural antibiotic prophylaxis in patients without biliary instrumentation or bypass undergoing hepatic artery embolization for hepatic malignancies
Abstract: Purpose: To assess the infection rate after eliminating postprocedural antibiotics in patients undergoing hepatic artery embolization (HAE) for primary and secondary hepatic malignancies. Material and Methods: In this historical cohort study, adults ≥18 years of age without prior biliary instrumentation or bypass who underwent HAE and received pre- and postprocedure antibiotic prophylaxis between September 1, 2014, and August 31, 2015, comprised group A, whereas similar patients receiving only preprocedure antibiotic prophylaxis between October 1, 2015, and September 30, 2016, comprised group B. Procedures conducted between September 1, 2015, and September 30, 2015, were excluded. The primary outcome was any infection occurring within 30 days of HAE. Results: A total of 150 patients underwent 204 HAE procedures in group A, and 171 patients underwent 221 procedures in group B. Cefazolin given as a 1-g dose (or 2 grams if obese) was administered in 391 of 425 evaluable procedures (92%). Clindamycin plus gentamicin was prescribed in 34 patients (8%) who had severe penicillin allergy. There was significant improvement in adherence to the postprocedure antibiotic regimen, from 68% (138 of 204 procedures) to 98% (216 of 221 procedures) (P < .001) with elimination of postprocedure prophylaxis. There were no significant differences in 30-day infection rates (5 [3%] vs. 5 [2%]; P = .57), hospital readmissions (13 [6%] vs. 12 [5%]; P = .68), or all-cause mortality (3 [1%] vs. 3 [1%]; P = .62) between the 2 groups. Conclusions: Elimination of postprocedural antibiotics after HAE did not lead to an increase in infectious complications. This finding supports the 2018 Society of Interventional Radiology recommendation for preprocedural prophylaxis only for HAE in the setting of an intact sphincter of Oddi. © 2019 SIR
Keywords: adult; controlled study; aged; major clinical study; diarrhea; liver cell carcinoma; cancer radiotherapy; gastrointestinal stromal tumor; melanoma; cohort analysis; abdominal pain; neuroendocrine tumor; pneumonia; patient compliance; liver cancer; bile duct carcinoma; clostridium difficile infection; gentamicin; hospital readmission; leiomyosarcoma; cryoablation; radiofrequency ablation; antibiotic prophylaxis; hepatic artery; infectious complication; perivascular epithelioid cell tumor; clindamycin; cefazolin; septicemia; arterial embolization; medication compliance; antimicrobial stewardship; human; male; female; priority journal; article; all cause mortality; microwave thermotherapy; penicillin allergy
Journal Title: Journal of Vascular and Interventional Radiology
Volume: 30
Issue: 12
ISSN: 1051-0443
Publisher: Elsevier Science, Inc.  
Date Published: 2019-12-01
Start Page: 1895
End Page: 1900
Language: English
DOI: 10.1016/j.jvir.2019.07.023
PUBMED: 31668968
PROVIDER: scopus
PMCID: PMC6874918
DOI/URL:
Notes: Article -- Export Date: 2 December 2019 -- Source: Scopus
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MSK Authors
  1. Susan Seo
    69 Seo
  2. Anne Covey
    125 Covey
  3. Karen T Brown
    169 Brown
  4. Elena Nadia Petre
    53 Petre