Staphylococcus aureus nasal carriage in 104 cirrhotic and control patients. A prospective study

BACKGROUND/AIMS: Bacterial infections, specially Staphylococcus aureus (S. aureus) septicemia, remain a leading cause of death following liver transplantation. It has been demonstrated that nasal carriage of S. aureus is associated with invasive infections in patients undergoing hemodialysis and could be decreased by use of antibiotic nasal ointment. However, in cirrhotic patients, the frequency of nasal carriage is unknown. The aims of this study were to determine the prevalence of S. aureus nasal carriage in cirrhotic patients and to assess nosocomial contamination. METHODS: One hundred and four patients were included in a prospective study, 52 cirrhotic and 52 control (hospitalized patients without cirrhosis or disease which might increase the rate of nasal carriage of S. aureus). On admission and after a few days of hospitalization, nasal specimens from each anterior naris were obtained for culture. S. aureus was identified by the gram strain, positive catalase and coagulase reactions; antibiotic susceptibility was determined using a disk-diffusion test. RESULTS: Both groups were similar with regard to age and sex. The prevalence of nasal colonization on hospital admission was 56% in cirrhotic patients and 13% in control patients (p = 0.001). After an average of 4 days, 42% of cirrhotics and 8% of control patients were colonized (p = 0.001), without any nosocomial contamination. Three strains out of 29 were oxacillin-resistant in cirrhotic patients, and none in controls (p>0.05). There was no statistical difference in carriage rate according to sex, age, cause of cirrhosis and Child-Pugh score. Previous hospitalization (OR, 6.3; 95% CI, 2.3 to 19.9; p = 0.0006) and cirrhosis (OR, 4.4; 95% CI, 1.5 to 13.4; p = 0.0048) were independent predictors of colonization. CONCLUSION: Cirrhotic patients had a higher S. aureus nasal carriage rate than control subjects. Previous hospitalization and cirrhosis diagnosis were correlated to nasal colonization. Further studies are necessary to determine if nasal decontamination could reduce S. aureus infections after liver transplantation.     

Postprandial variations in serum bile acid levels in humans free of hepatic or intestinal diseases (author's transl)

The levels of unsulfated, free or conjugated cholic, deoxycholic and chenodeoxycholic acids were measured using gas chromatography in 39 humans free of hepatic or intestinal diseases before and 10, 60, 120 and 180 min after ingestion of a standard meal. The probable maximal levels were determined with an error risk lower than 0.05. In fasting subjects, the observed values are comparable with those obtained by other authors working with gas chromatography or radioimmunoassay. Meal ingestion does not influence in the same way the serum levels of the various bile acids: the chemodeoxycholic serum level rose significantly in all cases whereas cholic and deoxycholic serum levels rose only in two-thirds of observed subjects; 60 and 120 min after the meal for chenodeoxycholic acid, and only 60 min after the meal for cholic acid, the mean values are significantly higher than the fasting ones; 120 min after the meal, the chenodeoxycholic and total bile acid probable maximal levels (respectively 7.4 and 10.3 micrometer) are twice the fasting ones. The cholic to chenodeoxycholic serum level ratio is nearly always lower than 1 but may reach 3. On the basis of these results, the validity and efficacy of the exploration tests based on serum bile acid level determinations are discussed.     

Are drugs a risk factor of post-ERCP pancreatitis?

Background

Pancreatitis is the most severe complication of ERCP. The aim of this study was to assess whether the use of potentially pancreatotoxic drugs is a risk factor for post-ERCP pancreatitis.

Methods

Risk factors for post-ERCP pancreatitis and all drugs taken during the month before ERCP were recorded retrospectively in a database. Patients with other causes of acute pancreatitis or chronic pancreatitis were excluded from the analysis. Post-ERCP pancreatitis was defined as abdominal pain and/or vomiting associated with amylase/lipase plasma levels equal to or greater than twice the upper normal value.

Results

A total of 173 patients (95 men, 78 women; mean age, 68 [16] years) were included. Post-ERCP pancreatitis occurred in 31 patients (18%). Several risk factors were identified in a multivariate analysis: difficulty in cannulation (p<0.001), endoscopic sphincterotomy (p<0.005), and female gender (p = 0.02). Having taken potent pancreatotoxic drugs increased the occurrence of post-ERCP pancreatitis: odds ratio 3.7: 95% confidence intervals [1.1,12.4], p = 0.04.

Conclusions

Use of pancreatotoxic drugs before or during ERCP significantly increased the risk of post-ERCP pancreatitis. Thus, discontinuation of the use of such drugs before ERCP seems justified whenever possible.