P0567 - Gastrointestinal Endoscopy 30-Day-Associated Bacteremia: Non-Outbreak Five Year Review in an Inner-City, Tertiary-Care Hospital

Fuad A. Khoury, MD, MPH¹, Muaz Aijazi, MD², Denise Araujo, MD³, Isabella Fons, BS⁴, Michael A. Pezzone, MD, PhD⁵, Mohamed Yassin, MD, PhD, MBA^5
1University of Pittsburgh Medical Center-Mercy, Pittsburgh, PA; ²University of Pittsburgh Medical Center, Pittsburgh, PA; ³UPMC Mercy, Pittsburgh, PA; ⁴Carnegie Mellon University, Pittsburgh, PA; ⁵University of Pittsburgh, Pittsburgh, PA

Introduction: Gastrointestinal endoscopic procedures (GIEP's) are an essential part of patient care both diagnostically and therapeutically. Post-GIEP infections may be higher than previously reported and may not have been accurately captured in the past, especially in hospitalized patients. The aim of this study was to determine the incidence and associated factors of bacteremia associated with inpatient and outpatient GIEP's as identified by a clinical surveillance infection control assistant.

Methods: This study analyzed 18,986 GIEPs performed over a five-year period (2018-2022) and identified patients with positive blood cultures within 30 days of procedure using electronic health records (EHR). Esophagogastroduodenoscopy (EGD), endoscopic retrograde cholangiopancreatography (ERCP), and colonoscopy/flexible sigmoidoscopy made up 17,093 of all GIEPs. Statistical analysis was performed using non-parametric testing to compare variables due to the small number of positive blood cultures.

Results: Bacteremia occurred in 52 patients (0.03%) with ERCP being the highest risk. EGDs, ERCPs, and colonoscopy/flexible sigmoidoscopies made up 24 (46.2%), 18 (34.6%) and 7 (13.5%) of cases, respectively. The overall average age was 64 years. Bacteremia occurred primarily in inpatients (92.3%) and in males (61.5%). Regarding GIEP duration, ERCP procedure took a median time of 32.5 minutes, longer than the median of EGD (20.1 minutes) and Colon/Flex Sig (21.29 minutes). Further, the median days between procedure and collection of cultures for ERCPs was 3.59, while for EGDs and Colon/Sigs it was 7.75 and 9.6, respectively.

The most common culture result across all patients was E. coli, at 26.9%. The overall proportion of GIEPs for which antibiotics were given within 48 hours is 44.2%, and proportion of antibiotics given is highest for ERCPs at 66.67% (compared to 40.74% for EGD and 0% for Colon/Flex Sig). The overall proportion of endogenous infection is 40.38%, and this proportion is highest for ERCP procedure at 72.22%. None of the procedures yielded exogenous infection.

Discussion: Our study showed a reflection of the endemic rate of infection post endoscopy. Our study cannot differentiate endogenous infection versus contaminated endoscopes. We made an effort to eliminate other causes of bacteremia. ERCP procedures are disproportionately associated with higher incidence of bacteremia.




Disclosures:


Fuad A. Khoury, MD, MPH¹, Muaz Aijazi, MD², Denise Araujo, MD³, Isabella Fons, BS⁴, Michael A. Pezzone, MD, PhD⁵, Mohamed Yassin, MD, PhD, MBA⁵. P0567 - Gastrointestinal Endoscopy 30-Day-Associated Bacteremia: Non-Outbreak Five Year Review in an Inner-City, Tertiary-Care Hospital, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.