ARRS 2022 Abstracts

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E1944. How Frequent Are Infectious Complications in Percutaneous Liver Tumor Ablation, and Are Prophylactic Antibiotics Utilized?
Authors
  1. Shivraj Grewal; University of Arizona College of Medicine - Phoenix
  2. Fawsia Osman; University of Chicago
  3. Daniel Crawford; Washington University in St. Louis
  4. Hamed Alattar; University of Arizona College of Medicine - Phoenix
  5. Leeann Qubain; University of Arizona College of Medicine - Phoenix
  6. Paul Kang; University of Arizona College of Medicine - Phoenix
  7. Eric vanSonnenberg; University of Arizona College of Medicine - Phoenix
Objective:
The use of prophylactic antibiotics in liver tumor ablation remains inconsistent and unclear. The literature lacks clarity about prophylactic antibiotics use for hepatic radiofrequency ablation, cryoablation, and microwave ablation. In this study, we reviewed the literature for hepatic tumor ablation and the use of prophylactic antibiotics as it relates to infectious complications.

Materials and Methods:
PubMed was searched for articles using MeSH terms for liver neoplasm, percutaneous ablation, radiofrequency ablation, cryoablation, microwave ablation, and filtered for clinical trials. Inclusion criteria involved: any malignant primary or secondary tumor of the liver, ablation modalities mentioned above, percutaneous procedures, and articles in English. Exclusion criteria involved unclear complication reporting, duplicate study populations, and electronically inaccessible articles. Data on complications, prophylactic antibiotic use or not, lesion characteristics, and procedure details were collected.

Results:
A total of 59 studies met our inclusion/exclusion criteria, and data were extracted for 5544 patients; 55/59 (93%) studies utilized radiofrequency, 7/59 (12%) microwave, and 1/59 (1.7%) cryoablation. When fever was included, potentially infectious complications occurred in 731/5544 (13.2%) patients. If excluded, infectious complications occurred in 34/5544 (0.6%) patients. Potentially infectious complications observed included: abscess, cholangitis, sepsis, fever, pneumonia, wound infection, cholecystitis, bacterial endocarditis, and unspecified abdominal infection. Prophylactic antibiotic use was reported in 1010/5544 (18.2%) patients across 5/59 (8.5%) studies. However, whether prophylactic antibiotics were used was not mentioned in 54/59 (91.5%) of studies.

Conclusion:
Fever is the leading potentially infectious complication in minimally invasive hepatic tumor ablation. This may stem from the post-ablation syndrome, seen in patients after ablation of solid tumors. Excluding fever, the low rates of infectious outcomes among hepatic tumor ablation suggest prophylactic antibiotics may be unnecessary. However, the use of prophylactic antibiotics may be underreported in tumor ablation studies. The use of antibiotics in tumor ablation studies was relatively low, as well as the rate of potentially infectious complications, when post-ablation syndrome symptoms such as fever were excluded.