An analysis of the incidence,causes and preventative approaches to gram-negative bloodstream infections of hepatopancreatobiliary origin

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.