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Abstract：
BACKGROUND: The American Society for Gastrointestinal Endoscopy recommends prophylactic antibiotics before endoscopic retrograde cholangiopancreatography (ERCP) in primary sclerosing cholangitis (PSC). We assessed the impact of this approach on the incidence of post-ERCP outcomes using nationwide data.
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.
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.
摘要：
背景：美国胃肠内镜学会建议在原发性硬化性胆管炎（PSC）的内镜逆行胰胆管造影术（ERCP）之前使用预防性抗生素。我们使用全国数据评估了这种方法对ERCP后结局发生率的影响。
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。
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。
