INFECTIOUS SEQUELAE AFTER ENDOSCOPIC SCLEROTHERAPY OF ESOPHAGEAL-VARICES - ROLE OF ANTIBIOTIC-PROPHYLAXIS

In order to determine the incidence of infection following sclerothera py and the role of antimicrobial prophylaxis, a prospective randomized control study was performed comparing i.v. imipenem/cilastatin, with an infusion of dextrose-saline as a control group. One hundred patient s with bleeding esophageal varices were included. All episodes of infe ction were documented during admission to the unit. Ninety-seven patie nts were evaluable. Post-sclerotherapy bacteremia developed in six (5. 6%) of 107 sclerotherapy sessions in the control group and one (1.1%) of the 88 sclerotherapy sessions in the imipenem/cilastatin group (P l ess-than-or-equal-to 0.1, NS); six of these seven post-sclerotherapy b acteremias occurred after emergency sclerotherapy. Infection within 7 days of the procedure was documented after 43 (22.1%) of the 195 scler otherapy sessions, 18 (20.5%) in the imipenem/cilastatin group and 25 (23.4%) in the control group (P = NS). These infections were significa ntly more common after emergency sclerotherapy, 40 (34.8%) of 115 sess ions, than after elective sclerotherapy, three (3.8%) of 80 sessions ( P less-than-or-equal-to 0.0001). A short prophylactic antibiotic regim e does not reduce the risk of early bacteremia or the frequency of inf ection after sclerotherapy. The higher risk of infection after emergen cy sclerotherapy may be therefore related more to the gastrointestinal hemorrhage and its associated effects than to sclerotherapy.