METHODS: Using 2015-2021 Nationwide Inpatient Sample data and relevant ICD-10 codes, we analyzed adult hospitalizations for PSC who underwent ERCP, with and without antibiotic prophylaxis. Hierarchical multivariate logistic regression analysis was used to assess the association between prophylactic antibiotic use and post-ERCP complications including sepsis, acute cholangitis, and acute pancreatitis.
RESULTS: We analyzed 32,972 hospitalizations for PSC involving ERCP, with 12,891 admissions (39.1%) receiving antibiotics before ERCP (cases) and 20,081 (60.9%) serving as controls. Cases were older than controls (mean age: 64.2 ± 8.6 vs. 61.3 ± 6.1 years; P = 0.020). Compared with controls, hospitalizations with antibiotic prophylaxis had a higher male population (7,541 (58.5%) vs. 11,265 (56.1%); P < 0.001) and higher comorbidity burden (Charlson comorbidity index score of ≥2: 5,867 (45.5%) of cases vs. 8,996 (44.8%) of controls; P = 0.01). Incidence of post-ERCP septicemia was 19.1% (6,275) with 2,935 incidences (22.8%) among cases compared with 3,340 (16.6%) among controls. Antibiotic prophylaxis did not significantly improve the odds of septicemia (aOR: 0.85; 95% CI: 0.77 - 1.09; P = 0.179). Approximately 2,271 (6.9%) cases of acute cholangitis and 5,625 (17.1%) cases of acute post-ERCP pancreatitis were recorded. After adjustments for multiple variables, no significant difference was observed in the odds of cholangitis (aOR: 0.87; 95% CI: 0.98 - 1.45; P = 0.08). However, antibiotic prophylaxis was correlated with a statistically significant reduction in the odds ratio of acute post-ERCP pancreatitis (aOR: 0.61; 95% CI: 0.57 - 0.66; P < 0.001).
CONCLUSIONS: The use of antibiotic prophylaxis in hospitalizations with PSC was correlated with a significant reduction in the odds of post-ERCP pancreatitis. Antibiotic prophylaxis did not improve the odds of post-ERCP sepsis or cholangitis. Prophylactic use of antibiotics should be individualized, considering both their anti-infective benefits and potential impact on the biochemical markers of liver disease.
方法:使用2015-2021年全国住院患者样本数据和相关ICD-10代码,我们分析了接受ERCP的PSC成人住院情况,有和没有抗生素预防。使用分层多变量逻辑回归分析评估预防性抗生素使用与ERCP后并发症(包括败血症)之间的关联。急性胆管炎,和急性胰腺炎。
结果:我们分析了32,972例涉及ERCP的PSC住院,12,891例(39.1%)患者在ERCP前接受抗生素治疗(病例),20,081例(60.9%)作为对照。病例年龄大于对照组(平均年龄:64.2±8.6vs.61.3±6.1年;P=0.020)。与对照组相比,接受抗生素预防的住院治疗的男性人群较高(7,541(58.5%)与11,265(56.1%);P<0.001)和更高的合并症负担(Charlson合并症指数评分≥2:5,867(45.5%)的病例与对照组为8,996(44.8%);P=0.01)。ERCP后败血症的发生率为19.1%(6,275),病例中有2,935例(22.8%),而对照组中有3,340例(16.6%)。抗生素预防并没有显著改善败血症的几率(aOR:0.85;95%CI:0.77-1.09;P=0.179)。记录了大约2,271例(6.9%)急性胆管炎和5,625例(17.1%)急性ERCP后胰腺炎。调整多个变量后,发生胆管炎的几率无显著差异(aOR:0.87;95%CI:0.98~1.45;P=0.08).然而,抗生素预防与急性ERCP后胰腺炎的比值比显著降低相关(aOR:0.61;95%CI:0.57~0.66;P<0.001).
结论:在PSC住院期间预防性使用抗生素与ERCP术后胰腺炎的几率显著降低相关。抗生素预防并不能改善ERCP后败血症或胆管炎的几率。预防性使用抗生素应个体化,考虑到它们的抗感染益处和对肝病生化标志物的潜在影响。