Table 1 Characteristics of seven patients with recurrent bacteremia following the injection of N-butyl-2-cyanoacrylate for the treatment of bleeding gastric varices
Case number | Gender | Age (years) | Underlying diseases | Time from application of N-butyl-2-cyanoacrylate to beginning of symptoms | Number of episodes with positive blood culture | Microorganism isolated from blood culture | Findings of the investigation | Treatment | Outcome | Long term antimicrobial secondary “prophylaxis” | |
|---|---|---|---|---|---|---|---|---|---|---|---|
Wahl P, 2004 [14] | 1 | Male | 60 | Alcoholic liver cirrhosis + portal hypertension | 3.5 months | 3 | 1st episode: Propionibacterium acnes + Actinomyces odontolyticus 2nd episode: Propionibacterium acnes Streptococcus anginosus + Prevotella species 3rd episode: Prevotella oralis | No significant findings | 1st episode: IVb ceftriaxone (duration not reported) 2nd episode: amoxicillin/clavulanate (duration not reported) 3rd episode: moxifloxacin (duration not reported) + surgical debridement of cyanoacrylate plug | Death | No |
2 | Male | 57 | Alcoholic liver cirrhosis + portal hypertension | 12 months | 2 | Enterobacter aerogenes | Inflammation around cyanoacrylate plug | IVb ceftriaxone (duration not reported) | Cure | Yes (oral ciprofloxacin for 3 months) | |
Wright G, 2009 [6] | 3 | Male | 38 | Alcoholic liver cirrhosis + portal hypertension | 6 months | 3 | ESBLa-producing E. coli | Cyanoacrylate embolism to inferior vena cava and left renal vein | IVb ertapenem for 6 months | Cure | No |
Galperine T, 2009 [4] | 4 | Male | 69 | Idiopathic portal thrombosis + portal hypertension | 6 months | 2 | Micromonas micros | Abscess contiguous to cyanoacrylate material | IVb clindamycin + impenem for 2 weeks | Cure | Yes (oral Cefuroxime for 3 months) |
5 | Male | 46 | Hepatitis B cirrhosis + portal hypertension + HIV | 2 weeks | 3 | Klebsiella pneumoniae | Cyanoacrylate embolism to spleen and left renal vein | IVb piperacilin/tazobactam for 2 weeks | Cure | Yes (oral amoxicillin/clavulanate for 6 weeks and then IVb ceftriaxone for 3 months) | |
Reuken PA, 2012 [2] | 6 | Male | 77 | Alcoholic liver cirrhosis + portal hypertension | 3 months | 2 | ESBLa-producing E. coli | Incomplete obliteration of gastric varices | IVb imipenem (duration not reported) + surgery with cardia resection + spleno-renal shunt | Death | No |
Present case | 7 | Male | 43 | Auto immune hepatitis and cirrhosis + portal hypertension + diabetes mellitus | 2 months | 3 | 1st episode: Streptococcus anginosus 2nd episode: Group C beta-hemolytic Streptococcus + E. coli 3rd episode: E. coli + E. faecalis | Cyanoacrilate embolism to perigastric and cardioprhenic veins | 1st episode: IVb ceftriaxone for 7 days 2nd episode: IVb ceftriaxone for 4 weeks 3rd episode: IVb ampicillin + ceftriaxone for 4 weeks | Cure | Yes (amoxicillin/clavulanate- indefinitely) |