Bacteremia with esophageal dilation

Background: Antibiotic prophylaxis has been recommended for selected patien ts undergoing esophageal stricture dilation because of a reported high rate of bacteremia, The aim of this study was to determine the rate of bacterem ia after esophageal dilatation in a large series and the source of the orga nisms recovered. Methods: Blood cultures and oral temperatures were obtained before esophage al dilation and at 5 and 30 minutes after dilation. Dilators were cultured immediately before dilation. Procedural data collected included type of dil ation, number of passes, and presence of malignancy. Results: Of 100 procedures in 86 patients undergoing esophageal dilation, 2 2 (22%) were associated with a positive post-dilation blood culture. Bacter emia was more frequent with dilation of malignant strictures compared with benign strictures (9 of 17 [52.9%] vs. 13 of 83 [15.7%], respectively, p = 0.002) and with passage of multiple dilators compared with passage of a sin gle dilator (16 of 46 [34.8%] versus 6 of 54 [11.1%], respectively, p = 0.0 07), Bacterial isolates from 22 positive blood cultures matched those from a dilator in only one episode (4.5%), Conclusion: The rate of bacteremia after esophageal ilation is 22% and is a ssociated with dilation of malignant strictures or passage of multiple dila tors. Organisms cultured from the blood are not transmitted from the dilato r.