Viridans streptococcal bacteremia after esophageal stricture dilation

Background: The incidence of bacteremia with organisms that may cause infec tive endocarditis after esophageal stricture dilation is unknown. There is disagreement among physicians regarding the need for antibiotic prophylaxis for patients with valvular heart disease undergoing dilation. Our aim was to determine the frequency and duration of bacteremia associated with esoph ageal stricture dilation. Methods: Blood cultures were obtained before and after stricture dilation i n patients without valvular heart disease and in a control group of patient s undergoing upper endoscopy without dilation. Results: A total of 103 patients undergoing dilation and 50 control patient s were studied; 22 of 103 patients (21%) undergoing dilation had at least o ne post-procedure blood culture positive for viridans streptococcus, compar ed with 1 of 50 (2%) of control patients (p = 0.001). Blood cultures obtain ed 1 minute after stricture dilation were positive for viridans streptococc us in 19 of 81 (23%), in 16 of 96 (17%)5 minutes post-dilation, and in 3 of 63 (5%) 20 to 30 minutes post-dilation. Of the 19 patients with viridans s treptococcus bacteremia 1 minute after dilation, cultures were still positi ve In 14 of 19 (74%) at 5 minutes and in 2 of 19(10%) 20 to 30 minutes post -dilation. Conclusions: These data support the use of antibiotic prophylaxis before es ophageal stricture dilation for patients with valvular heart disease at ris k for the development of infective endocarditis.