Risk Factors and Prevention of Early Infection After Implantation or Revision of Transjugular Intrahepatic Portosystemic Shunts (Results of a Randomized Study)

Abstract

The aim of this study was to evaluate theefficacy of a single dose of a second-generationcephalosporine to prevent postinterventional infectionand to identify risk factors for postinterventionalinfection in patients receiving implantation or revisionof a transjugular intrahepatic portosystemic shunt(TIPS). Eighty-four patients (105 transjugularinterventions) were randomized receiving no antibiotictreatment (46 interventions) or 2 g cefotiam (56interventions) given at the beginning of the procedure.Patients with overt infection or those receivingantibiotic treatment in the preceding two weeks wereexcluded. Groups were comparable with respect tobiographic and medical data. Postinterventionalinfection was defined as an increase in WBC count(≥15,000/μl), fever (38.5°C), or a positiveblood culture. Infection occurred in 17% of the patients. Patients notreceiving cefotiam had a slightly higher incidence ofinfection (20%) than patients treated with cefotiam(14%, NS). Multivariate analysis demonstrated prognostic relevance for multiple stenting andperiprocedural use of a central venous line. Theclinical outcome of the patients was unaffected bycefotiam treatment. In conclusion, a single dose ofintrainterventional cefotiam does not prevent postinterventionalinfection. This may be due to the antimicrobial spectrumand short half-time of cefotiam. Strict adherence toaseptic conditions during intervention and early removal of central venous lines may reduce therate of post interventional infection considerably.Antibiotic prophylaxis with cefotiam does not seem to beuseful since it will not influence outcome andcosts.