A Prospective Investigation Of Antibiotic Prophylaxis Usage For Vascular Interventional Procedure

Objective This prospective randomized trial is to investigate the necessary of antibiotic prophylaxis usage for vascular interventional procedures in patients withoutpre-procedure infection.Materials and Methods : Ninety-eight patients( 115 vascular intervention procedures) without pre-procedure infection were randomized to divided into two groups. Among them, 14 procedures for angiography, 22 for transcatheter arterial infusion(TAI) and 79 for transcatheter arterial chemo-embolization(TACE) . It was excluded that the patients suffered overt infection or received antibiotic treatment in two weeks before the procedures. The patients in group A (55 procedures) received antibiotic prophylaxis usage (one dose of cefazolin 2g by introvenous injection in 30 minutes before the procedure), while patients in group B (60 procedures ) received no antibiotics prophylaxis usage . After the procedures, no antibiotic was administered again in two groups. The axillary temperature, white blood cell (WBC) count, C-reaction protein(CRP) and patients' body signs was observed and followed up for one month. Blood culture was performed when the patient was suspected of suffering from sepsis. The diagnosis of postoperative infection was decided double-blindly by two experienced physicians referring to Diagnostic Criteria for Hospital Infection published in 2001 by the Ministry of Health(MOH) of People's Republic of China . Infection rates in two groups were compared .Results: Fever(axillary temperature over 37.5°C) occurred in 35 procedures , 16 caseswas in group A, 19 cases was in group B. Elevated WBC count (>10,000/ul) was found in 10 procedures, 4 were in group A and 6 were in group B. blood culture in 2 cases and liver necro-fluid culture in 1 case were negative. One case was diagnosed as sepsis respectively in both group by the two physicians . The infection rates were 1.9% (1/55) in group A, andl.7% (1/60) in group B. There were no statistically significant difference in the infection rates between the two groups (P>0.05) .Conclusion: Prophylactic antibiotics is not necessary for vascular interventional procedure in the condition without pre-procedure infection.KEYWORDS Vascular; intervention Radiology; Antibiotic Prophylaxis, therapeuticPart 2 Analysis of the Affecting Factors of post- TACEFever in Liver CancerObjective To investigate the affecting factors of post-TACE (transcatheter arterial chemo-embolization ) fever in patients with liver cancerMaterials and Methods Clinical data of forty-five patients with liver cancer who underwent TACE (60 procedures) were reviewed. The affecting factors of post-TACE fever was analyzed. 15 Clinical parameters were determined as independent variables including the patient' ages, Okuda stage , tumor classify, presence of ascites, the amounts of lipiodol used , using embolus, preoperative serum glutamic pyruvic transaminase(SGPT), total bilirubin(TBIL), albumin(ALB) ,alpha-fetoprotein(AFP) , red blood cell count (RBC) ,white blood cell count (WBC), platelet count (PLT), prothrombin time(PT) , history of TACE ,while the numbers of days running a fever after the procedure of the patients were determined as dependent variables. Amultivariate stepwise regression analysis was performed to determine the factors that had affected the duration of fever.Results The factors that affected fever after TACE , in the descending order of theabsolute value of the regression coefficient , were the dose of lipiodol used( p=0. 005 ) , using embolus ( p=0. 019 ) Okuda stage ( p=0. 037 ) , ages(p=0. 724) , tumor classify (p=0. 989) . The volume of lipiodol used had played themost important role in affecting febrile time.Conclusions The amounts of lipiodol used is the important factor affecting the post-treatment fever in patients with liver cancer undergone TACE with a tendency of intensification by using embolus. The systemic state and the regional state of the liver before the treatments including of Okuda stage, tumor classification and the patient's ages also play some parts in affecting the post-treatment fever.