Researchers Compare Antibiotic Prophylactic Regimens for Infection Prevention After Hepatic Embolotherapy

Antibiotic prophylaxis does not appear to reduce the risk of infectious complications after embolotherapy in patients who have previously undergone biliary procedures, according to an abstract presented at the 2017 World Conference on Interventional Oncology in Boston, Massachusetts.

In a retrospective analysis, researchers reviewed data on 881 patients who underwent 1,588 lipiodol-based chemoembolization (TACE) procedures and 331 patients who underwent 517 radioembolization (TARE) procedures. The procedures took place from 2010 to 2016.

Of these procedures, 13 TACE and 49 TARE were done in patients who had prior biliary procedures. To prevent infection, 20 of these patients were given 400 mg of oral moxifloxacin monotherapy daily for 3 days prior to 17 days post-embolization, and 40 were given a multi-drug regimen. The multi-drug regimen was typically 500 mg levofloxacin daily and 500 mg metroniodazole twice daily 2 days before until 14 days after the procedure, in addition to 1 g oral neomycin and 1 g oral erythromycin 3 times the day before the procedure.

Infection incidence among patients with prior biliary interventions was 15% post-TACE and 4% post-TARE, which was significantly higher than infection incidence in patients without prior biliary interventions (0.2% post-TACE and 0.2% post-yttrium-90).

However, the different antibiotic prophylaxis regimens taken by patients with prior biliary interventions did not yield significantly different infection rates. Infection incidence was also similar between embolotherapies in patients with prior biliary interventions.

“The incidence of infectious complications occurring after embolotherapy is significantly greater in patients with prior biliary interventions compared to those with intact biliary anatomy even with the use of extended antibiotic prophylaxis. The rate of infectious complications is similar for moxifloxacin monotherapy and a multidrug regimen,” the researchers concluded.

Reference

Abousoud O, Hunt SJ, Gade T, et al. Comparison of infection rates in patients with prior biliary interventions undergoing hepatic embolotherapy treated with single-drug moxifloxacin versus multi-drug antibiotic prophylaxis. World Conference on Interventional Oncology. June 8-11,2017.