Example: quiz answers

Antibiotic prophylaxis for GI endoscopy

GUIDELINEA ntibiotic prophylaxis for GI endoscopyThis is one of a series of statements discussing the use ofGI endoscopy in common clinical situations. The Stan-dards of Practice Committee of the American Society forGastrointestinal endoscopy (ASGE) prepared this docu-ment, and it updates a previously issued document onthis preparing this guideline, MEDLINE andPubMed databases were used to search for publicationsbetween January 1975 and December 2013 pertainingto this topic. The search was supplemented by accessingthe related articles feature of PubMed, with articlesidentified on MEDLINE and PubMed as the references were obtained from the bibliogra-phies of the identified articles and from recommenda-tions of expert consultants.

FNA, is within the range of that for diagnostic upper endos-copy. Prospective studies in patients undergoing EUS-guided FNA (EUS-FNA) of cystic or solid lesions along the upper GI tract indicate a low prevalence of procedure-related bacteremia, ranging from 4.0% to 5.8%.24-27 Similarly, EUS-FNA of solid rectal and perirectal

Tags:

  Copy, Done, Endoscopy, Endos copy

Information

Domain:

Source:

Link to this page:

Please notify us if you found a problem with this document:

Other abuse

Transcription of Antibiotic prophylaxis for GI endoscopy

1 GUIDELINEA ntibiotic prophylaxis for GI endoscopyThis is one of a series of statements discussing the use ofGI endoscopy in common clinical situations. The Stan-dards of Practice Committee of the American Society forGastrointestinal endoscopy (ASGE) prepared this docu-ment, and it updates a previously issued document onthis preparing this guideline, MEDLINE andPubMed databases were used to search for publicationsbetween January 1975 and December 2013 pertainingto this topic. The search was supplemented by accessingthe related articles feature of PubMed, with articlesidentified on MEDLINE and PubMed as the references were obtained from the bibliogra-phies of the identified articles and from recommenda-tions of expert consultants.

2 When few or no data wereavailable from well-designed prospective trials, emphasiswas given to results from large series and reports fromrecognized experts. Weaker recommendations are indi-cated by phrases such as We suggest. whereas strongerrecommendations are stated as We recommend. Thestrength of individual recommendations was based onboth the aggregate evidence quality (Table 1)2and anassessment of the anticipated benefits and guidelines for appropriate use of endoscopy arebased on a critical review of the available data andexpert consensus at the time that the documents aredrafted. Further controlled clinical studies may beneeded to clarify aspects of this document.

3 This guidelinemay be revised as necessary to account for changes intechnology, new data, or other aspects of clinical practiceand is solely intended to be an educational device to pro-vide information that may assist endoscopists inproviding care to patients. This document is not a ruleand should not be construed as establishing a legal stan-dard of care or as encouraging, advocating, requiring,or discouraging any particular treatment. Clinical deci-sions in any particular case involve a complex analysisof the patient s condition and available courses of , clinical considerations may lead an endoscop-ist to take a course of action that varies from the recom-mendations and suggestions proposed in this translocation of endogenous microbialflorainto the bloodstream may occur during endoscopybecause of mucosal (or deeper) trauma related to theprocedure.

4 endoscopy -related bacteremia carries a smallrisk of localization of infection in remote tissues (ie, infec-tive endocarditis [IE]). endoscopy also may result in localinfections in which a typically sterile space or tissue isbreached and contaminated by an endoscopic accessoryor by contrast material injection. This document is an up-date of the prior ASGE document on Antibiotic prophylaxisfor GI endoscopy ,1discusses infectious adverse eventsrelated to endoscopy , and provides recommendations forperiprocedural Antibiotic ASSOCIATED WITHENDOSCOPIC PROCEDURESB acteremia can occur after endoscopic procedures andhas been advocated as a surrogate marker for IE risk. How-ever, clinically significant infections are extremely an estimated million colonoscopies, sigmoidoscopies, and perhaps as many up-per endoscopies performed in the United States eachyear,3only approximately 25 cases of IE have been reportedwith temporal association to an endoscopic are no data demonstrating a causal association be-tween endoscopic procedures and IE or that Antibiotic pro-phylaxis prior to endoscopic procedures protects againstIE.

5 Finally, much of the existing data reflects estimatedrisk associated with conventional endoscopic are no results available that confidently quantifybacteremia rates with newer endoscopic procedures suchas per oral endoscopic myotomy, endoscopic submucosaldissection, or endoscopic mucosal associated with a high risk ofbacteremiaThe highest rates of bacteremia have been reportedwith esophageal dilation, sclerotherapy of varices, andinstrumentation of obstructed bile ducts. The rate ofbacteremia following esophageal bougienage was demon-strated to be 12% to 22% in 3 prospective usually are commensal to the mouth. In 1 study,Streptococcus viridanswas the organism isolated in 79%of may be more frequent with dilationof malignant strictures than with benign also may be more frequent with passage of multipledilators compared with a single of bacteremia associated with variceal sclero-therapy have been reported to be as high as 52%, with amean of variceal ligation, whichCopyright 2015 by the American Society for Gastrointestinal Endoscopy0016-5107/$ 81, No.

6 1 : 2015 GASTROINTESTINAL ENDOSCOPY81has largely replaced sclerotherapy, has been associatedwith bacteremia rates of 1% to 25%, with a mean ERCP in patients with non-obstructed bileducts has been associated with a low rate of bacteremiaof , the incidence increases to 18% in the setting ofbiliary obstruction because of stones or associated with a low risk ofbacteremiaGastroscopy with or without biopsy is associated withrates of bacteremia up to 8%, with a mean of observed bacteremia usually is short lived (!30 min-utes) and not associated with infectious adverse of bacteremia associated with colonoscopy havebeen reported to be as high as 25%, with a mean is uncommon ( ) even with thera-peutic colon procedures such as colonic stent rate of bacteremia withflexible sigmoidoscopy is!

7 1%.22,23 There are no data on the risk of bacteremia associatedwith device-assisted enteroscopy (eg, single-balloon anddouble-balloon enteroscopy, spiral enteroscopy), but it islikely small and comparable to that of routine upper andlower endoscopic frequency of bacteremia after EUS, with or withoutFNA, is within the range of that for diagnostic upper endos- copy . Prospective studies in patients undergoing EUS-guided FNA (EUS-FNA) of cystic or solid lesions alongthe upper GI tract indicate a low prevalence ofprocedure-related bacteremia, ranging from , EUS-FNA of solid rectal and perirectallesions is associated with a low risk of bacteremia, with1 study reporting a risk of 2%.

8 28 Bacteremia associated with routine dailyactivityTransient bacteremia occurs frequently during routinedaily activity, often at rates exceeding those associatedwith endoscopic procedures. Brushing andflossing ofteeth has been associated with rates of bacteremia of20% to 68%, use of toothpicks with rates of 20% to 40%,and even activity that might be considered entirely physio-logic, such as chewing food, with rates ranging from 7% to51%.29 Given the relative rarity with which most individualsundergo endoscopic procedures, the frequency and risk ofendoscopy-related bacteremia is trivial compared with thefrequency of bacteremia encountered with routine daily ac-tivity. This provides a strong rationale against routineadministration of Antibiotic prophylaxis for IE prior toendoscopic prophylaxis FOR GIENDOSCOPIC PROCEDURESThe purpose of Antibiotic prophylaxis during GI endos- copy is to reduce the risk of iatrogenic infectious adverseevents.

9 Recommendations for Antibiotic prophylaxis aresummarized inTables 2 and of IEThe 2007 American Heart Association (AHA) guidelinesfor prophylaxis of IE stated that the administration ofprophylactic antibiotics solely to prevent IE was no longerrecommended for patients undergoing GI AHA based its recommendations on several lines ofevidence including (1) cases of IE associated with GI pro-cedures are anecdotal, (2) no data demonstrate a conclu-sive link between GI procedures and the development ofIE, (3) there are no data that demonstrate that antibioticprophylaxis prevents IE after GI-tract procedures, (4) IEis more likely to be caused by bacteremia resulting fromusual daily activities, and (5) an extremely small numberof cases of IE may be prevented even if Antibiotic prophy-laxis were 100% AHA also delineated cardiac conditions associatedwith the highest risk of an adverse outcome from IE,including (1) prosthetic (mechanical or bioprosthetic) car-diac valves, (2) history of previous IE, (3) cardiac transplantrecipients who develop cardiac valvulopathy, and (4) pa-tients with congenital heart disease (CHD) including thosewith unrepaired cyanotic CHD including palliative shuntsand conduits.

10 Those with completely repaired CHD withprosthetic material or devices, placed surgically or by cath-eter, for thefirst 6 months after the procedure; and thosewith repaired CHD with residual defects at the site or adja-cent to the site of a prosthetic patch or 1. GRADE system for rating the quality ofevidence for guidelines2 Quality ofevidenceDefinitionSymbolHighFurther research is very unlikelyto change our confidence in theestimate of Further research is likely to havean important impact on ourconfidence in the estimate ofeffect and may change research is very likely tohave an important impact onour confidence in the estimateof effect and is likely to changethe lowAny estimate of effect is prophylaxis for GI endoscopy82 GASTROINTESTINAL ENDOSCOPYV olume 81, No.


Related search queries