659. Epidemiology and Clinical Characteristics of Bacteremia Following Portal Vein Embolization

TL;DR

This study examines the occurrence and features of bacteremia following portal vein embolization, a procedure used before liver surgery.

Contribution

The paper provides new insights into the epidemiology and clinical characteristics of bacteremia after portal vein embolization.

Findings

Bacteremia occurred in 3.5% of portal vein embolization patients, with Enterococcus spp. being the most common pathogen.

Patients with cholangiocarcinoma and those undergoing biliary drainage had a higher risk of post-PVE bacteremia.

Bacteremia was associated with longer hospital stays and higher complication rates compared to non-bacteremia cases.

Abstract

Portal vein embolization (PVE) is performed to induce liver hypertrophy before major hepatectomy. As an invasive procedure, PVE can lead to complications such as bacteremia, which may result in multi-organ failure. Despite its clinical importance, studies on bacteremia following PVE are limited. This study aimed to examine the epidemiology and clinical characteristics of post-PVE bacteremia.Table 1.Comparison of baseline characteristics and clinical outcomes between ‘bacteremia group’ and ‘ non-bacteremia group’.Note: Data are numbers (%) of patients, unless otherwise indicated.Abbreviations: IQR, interquartile range; IHD, ischemic heart disease; CVA, cerebrovascular accident; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; CKD, chronic kidney disease; CCC, cholangiocarcinoma; ENBD, Endoscopic Nasobiliary Drainage; ERBD, Endoscopic Retrograde Biliary Drainage; PTBD, Percutaneous Transhepatic Biliary Drainage; PTGBD, Percutaneous Transhepatic Gallbladder Drainage.* Fisher’s exact testa It includes liver metastasis, combined hepatocellular-cholangiocarcinoma and gallbladder cancer.Table 2.Etiology of post-portal vein embolization bacteremia.

Comparison of baseline characteristics and clinical outcomes between ‘bacteremia group’ and ‘ non-bacteremia group’.

Note: Data are numbers (%) of patients, unless otherwise indicated.

Abbreviations: IQR, interquartile range; IHD, ischemic heart disease; CVA, cerebrovascular accident; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; CKD, chronic kidney disease; CCC, cholangiocarcinoma; ENBD, Endoscopic Nasobiliary Drainage; ERBD, Endoscopic Retrograde Biliary Drainage; PTBD, Percutaneous Transhepatic Biliary Drainage; PTGBD, Percutaneous Transhepatic Gallbladder Drainage.

* Fisher’s exact test

a It includes liver metastasis, combined hepatocellular-cholangiocarcinoma and gallbladder cancer.

Etiology of post-portal vein embolization bacteremia.

We retrospectively analyzed adult patients (≥18 years) who developed bacteremia within 30 days of PVE at a single tertiary center (Feb 2014–Mar 2024). Patients with bacteremia after 30 days or post-hepatectomy were excluded. A 1:2 propensity score matching by age, sex, and procedure date was used to select controls without bacteremia. Clinical and microbiological characteristics were compared between bacteremia group and nonbacteremia group.

Among 1,768 PVE patients, 62 (3.5%) developed bacteremia. Of these, 48 (77.4%) had no other major complications, while 14 (22.6%) had. Enterococcus spp. (35.5%) was the most common pathogen followed by Escherichia coli (21.0%). Extended-spectrum cephalosporins were most frequently used before procedure (77.8%), while beta-lactam/beta-lactamase inhibitors were most frequently used after bacteremia (51.7%) as emprical antibiotics. Median time from PVE to bacteremia was 3 days (IQR 1–7); median bacteremia duration was 1 day (IQR 1–1). Compared to controls, the bacteremia group had more cholangiocarcinoma and fewer hepatocellular carcinoma cases (P < 0.001), and more frequent pre-procedural biliary drainage (83.9% vs. 31.5%, P < 0.001), especially ENBD and ERBD. Rates of post-PVE fever (87.1% vs. 28.2%), pre-procedure broad-spectrum antibiotic use (59.7% vs. 16.9%), and any complications (45.2% vs. 2.4%) were significantly higher (all P < 0.001) in bacteremia group than those of nonbacteremia group. Additionally, time to surgery (30 vs. 26 days, P = 0.048) and hospital stay (25 vs. 9 days, P < 0.001) were longer in the bacteremia group than those of nonbacteremia group.

Post-PVE bacteremia was more frequent in patients with cholangiocarcinoma, particularly those undergoing ENBD or ERBD. Enterococcus spp. was the most frequent causative organism.

All Authors: No reported disclosures

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