Infection after ERCP, and antibiotic prophylaxis: a sequential quality-improvement approach over 11 years

BackgroundInfection is a known complication of ERCP procedures, and the role of antibiotic prophylaxis is uncertain.ObjectiveTo document the incidence of infection after ERCP while changing the policy for antibiotic prophylaxis.DesignRetrospective analysis of data collected prospectively on infection complications, with progressive reduction in the use of prophylactic antibiotics.SettingSingle-center university referral hospital.PatientsA total of 11,484 ERCP procedures were documented prospectively over a period of 11 years.InterventionsAfter baseline assessment, the use of prophylactic antibiotics was sequentially reduced and simplified in 3 phases.Main Outcome MeasurementsIncidence of infection, categorized by severity.ResultsThe infection rate was low overall and decreased significantly with time, from 0.48% to 0.25%, despite a marked reduction in the proportion of patients given antibiotics (from 95% to 25%). Multivariate analysis also showed that the only category of patients at increased risk for infection (despite antibiotics) was the subgroup undergoing interventions for biliary problems after liver transplantation.LimitationsA lack of routine follow-up may mean that some delayed infectious complications were not recorded. The low risk of infection in this series may reflect the high technical success rate for relief of biliary obstruction; thus, our current minimalist antibiotic policy may not be generalizable to community practice.ConclusionsInfectious complications of ERCP can be kept to a minimum with a limited use of prophylactic antibiotics.