P2749 - Efficacy of Antibiotic Prophylaxis in Preventing Infections Following Endoscopic Retrograde Cholangiopancreatography: A Systematic Review and Meta-Analysis

Nouman Shafique, MD¹, Fnu Muhibullah, MD, MBBS², Abdul Qadeer, ³, Nihal I. Khan, MD¹, Syed Hamaad Rahman, DO⁴, Muhammad Zaeem, MD¹, Sana Aleem, MD³, Abdullah Abbasi, MBBS, MD, MRCP⁵, Adeena Shafique, ⁶, Iqra Shafiq, MBBS⁷, Muhammad Naveed, MBBS⁸, Faizan Ahmed, MBBS⁹, Hafiz Khan, MD¹⁰, Abu Hurairah, MD^1
1AdventHealth Medical Group, AdventHealth, Orlando, FL; ²West Virginia University Camden Clark Medical Center, Parkersburg, WV; ³Nishtar Medical University, Multan, Punjab, Pakistan; ⁴Methodist Dallas Medical Center, Irving, TX; ⁵Centre of Interventional Endoscopy at AdventHealth, Orlando, FL; ⁶Aga Khan University, Karachi, Sindh, Pakistan; ⁷Combined Military Hospital, Bahawalpur, Punjab, Pakistan; ⁸Dow Medical College, Karachi, Sindh, Pakistan; ⁹Ameer Ud Din Medical College/ Lahore General Hospital, Lahore, Punjab, Pakistan; ¹⁰SUNY Upstate Medical University, Syracuse, NY

Introduction: Antibiotic prophylaxis is commonly used to prevent infections following endoscopic retrograde cholangiopancreatography (ERCP). However, its efficacy in reducing various infection-related outcomes remains debated. Our study aims to evaluate the effectiveness of antibiotic prophylaxis in preventing bacteremia, cholangitis, pancreatitis, septicemia, and overall mortality in patients undergoing ERCP.

Methods: A comprehensive literature search was conducted using PubMed, EMBASE, and Cochrane Library to identify studies comparing antibiotic prophylaxis with placebo in patients undergoing ERCP. Inclusion criteria included randomized controlled trials (RCTs) and observational studies reporting outcomes related to bacteremia, cholangitis, pancreatitis, septicemia, and overall mortality. A random-effects model was utilized to pool effect sizes of the extracted data, and the primary endpoint was the incidence of post-ERCP infections, including bacteremia, cholangitis, pancreatitis, and septicemia, as well as overall mortality rates within the follow-up period.

Results: We included 10 studies with 2,007 patients. Our results showed a statistically significant reduction in bacteremia (RR: 0.5059 [0.2794; 0.9158]; I²=31.6%; p=0.0244) and a borderline significant reduction in septicemia (RR: 0.3942 [0.1513; 1.0266]; I²=13.1%; p=0.0566) in patients receiving antibiotic prophylaxis compared to placebo. The patients receiving antibiotic prophylaxis showed a trend towards reduction in cholangitis (RR: 0.5656 [0.2756; 1.1607]; I²=38.1%; p=0.1202) and pancreatitis (RR: 0.7104 [0.3555; 1.4196]; I²=30.1%; p=0.3331), however these results were not statistically significant. There was no difference in overall mortality (RR: 1.1439 [0.3341; 3.9168]; I²=27.1%; p=0.8304) in patients receiving placebo or antibiotics.

Discussion: Our meta-analysis indicates antibiotic prophylaxis significantly reduces bacteremia and shows significant reduction in septicemia following ERCP, highlighting its potential benefit in preventing these infections. However, the trends towards reduced cholangitis and pancreatitis were not statistically significant, indicating the need for further investigation. These findings suggest that while antibiotic prophylaxis can be effective in reducing certain infection-related outcomes, its impact on overall mortality remains uncertain. Future studies should focus on larger sample sizes and longer follow-up periods to better understand the full scope of its efficacy.



Disclosures:


Nouman Shafique, MD¹, Fnu Muhibullah, MD, MBBS², Abdul Qadeer, ³, Nihal I. Khan, MD¹, Syed Hamaad Rahman, DO⁴, Muhammad Zaeem, MD¹, Sana Aleem, MD³, Abdullah Abbasi, MBBS, MD, MRCP⁵, Adeena Shafique, ⁶, Iqra Shafiq, MBBS⁷, Muhammad Naveed, MBBS⁸, Faizan Ahmed, MBBS⁹, Hafiz Khan, MD¹⁰, Abu Hurairah, MD¹. P2749 - Efficacy of Antibiotic Prophylaxis in Preventing Infections Following Endoscopic Retrograde Cholangiopancreatography: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.