An analysis of the incidence, causes and preventative approaches to gram-negative bloodstream infections of hepatopancreatobiliary origin. Issue 3 (May 2021)

• Record Type: Journal Article
• Authors: Majeed, Mustafa; Ward, Harry; Wade, Cian; Butcher, Lisa; Soonawalla, Zahir; Bond-Smith, Giles
• Is Part Of: Journal of infection prevention. Volume 22:Issue 3(2021)
• Page Start: 111
• Page End: 118
• Publication Date: 2021-05
• Subjects: Gram-negative -- bloodstream infection -- infection prevention -- hepatopancreatobiliary -- gallstones -- malignancy; Hospital buildings -- Sanitation -- Periodicals; Communicable diseases -- Prevention -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Cross infection -- Prevention -- Periodicals; 616.9045
• DOI: 10.1177/1757177420973763
• Languages: English
• ISSNs: 1757-1774

Abstract

Background: Gram-negative bloodstream infection (GNBSI) is a threat to public health in terms of mortality and antibiotic resistance. The hepatopancreatobiliary (HPB) cohort accounts for 15%–20% of GNBSI, yet few strategies have been explored to reduce HPB GNBSI. Aim: To identify clinical factors contributing to HPB GNBSI and strategies for its prevention. Methods: We performed a retrospective analysis of 433 cases of HPB GNBSI presenting to four hospitals between April 2015 and May 2019. We extracted key data from hospital and primary care records including: the underlying source of GNBSI; previous documentation of biliary disease; and any previous surgical or non-surgical management. Findings: Out of 433 cases of HPB GNBSI, 388 had clear evidence of HPB origin. The source of GNBSI was related to gallstone disease in 282 of the 388 cases (73%) and to HPB malignancy in 70 cases (18%). Of the gallstone-related cases, 117 had previously been diagnosed with symptomatic gallstones. Of the 117 with a previous presentation, 93 could have been prevented with a laparoscopic cholecystectomy at the first presentation of gallstones, while 18 could have been prevented if intraoperative biliary tract imaging had been performed during a prior cholecystectomy. Of the 70 malignant cases, five could have been prevented through earlier biliary stenting, use of metal stents instead of plastic stents or earlier pancreaticoduodenectomy. Discussion: The incidence of HPB GNBSI could be reduced by up to 30% by the implementation of alternative management strategies in this cohort.