| Summary: | 碩士 === 高雄醫學大學 === 公共衛生學系公共衛生學碩士班 === 105 === Background and Objective: Whether transcatheter arterial (chemo)embolization [TA(C)E] or radiofrequency ablation (RFA) carries the risk of infection. The issue of prophylactic antibiotic agents before and after the procedure is controversial. Fever often develop in patients with HCC receiving TA(C)E or RFA. Practitioner may concern sepsis development or subsequent liver abscess formation and prescribe broad spectrum antibiotic agents once fever is recognized after the procedure despite the low reported incidence rate of sepsis. We aim to investigate parenteral broad spectrum antibiotic consumption among patients with hepatocellular carcinoma (HCC) undergoing RFA or TA(C)E and the incidence of post procedure infection complications.
Methods: We requested data on patients with HCC who underwent TA(C)E or RFA during hospitalization between 2004 and 2013 from the Taiwan National Health Insurance(NHI) program and also reviewed the computerized medical records between January 2015 and May 2015 in Kaohsiung Chang Gung Memorial Hospital(KCGMH) and found procedures of RFA or TA(C)E were performed during this period. Differences in demographics, co-morbidity, post-treatment fever, antibiotic use and infection complications were compared between patients who received RFA and TA(C)E.
Results: From the NHIRD, Taiwan, there is an increasing trend of broad spectrum antibiotics prescription among patients with HCC receiving TA(C)E or RFA from 2004 to 2013. The percentage of broad spectrum antibiotics use was 13.99%. Broad spectrum antibiotics used with RFA were 1.49 times (95% CI, 1.21-1.84) of those used with TA(C)E. Patient with liver cirrhosis were less prescribed broad spectrum antibiotics than those without liver cirrhosis (OR: 0.59, 95% CI:0.49~0.71). In KCGMH, among 414 TA(C)E procedures, there were 10.14% broad spectrum antibiotic prescribing with 17 documented bacterial infection according to discharge diagnosis. The incidence of procedure associated bacteremia or hepatic abscess formation is 1.21%. As for 309 RFA procedures, the percentage of broad spectrum antibiotic prescribing is 8.09% with 4 documented bacterial infection. The incidence of procedure related infection complication is 0.97%. Post procedure fever is an independent predictor of antibiotic prescribing.
Conclusions: Universal pre and post TA(C)E or RFA prophylactic antibiotic use may be not necessary. Transient postprocedure fevers are ususally attributed to postablation and postembolization syndrome and are not thought to represent bacteremia. Careful clinical evaluation bring a more judicious use of antibiotic.
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