A Prospective Investigation Of Antibiotic Prophylaxis Usage For Nonvascular Interventional Procedures

Part 1Percutaneous Intradiscal Ozone-injection Treating Lumbar DiscHerniationObjectiveTo randomized investigate prospectively the feasibility of percutaneous intradiscal ozone-injection treating lumbar disc herniation without antibiotic prophylaxis usage in the period of peri-procedures and to analyze the risk factors of infection under the condition. Materials and MethodsEighty-three patients with lumbar disc herniation were divided into three groups at random. All these patients were injected with 6-10ml medical ozone into discs with 21G needles under fluoroscopic guidance, and another 10ml medical ozone into the paravertebral space when withdrawing the needle. The ozone concentration was 40ug/ml. Those who were all normal in temperature and three routine examinations (vein blood, urine, dejecta) and CRP were divided into three groups. Prophylaxis A group (25 cases) were infused with Cephalothin V 2.0g intravenously within 30 minutes before the procedure. Prophylaxis B group (30 cases) adopted Clindamycin1.8g infusing intravenously 3 days after the procedure. The contrast group (28 cases) received no antibiotics before or during the procedure. No further antibiotic administration was given in the three groups post-procedures. The patients were followed up for armpit temperature, white blood cell (WBC) count, C-reactive protein (CRP) and body signs for 3 to 6 months' following after the procedures. The diagnosis criteria of lumbar disc infection according to Diagnostic Criteria for Hospital Infection published by the Ministry of Health of the People's Republic of China in 2001. Statistical analysis was done between three groups with the value of WBC and NEU% and CRP above the standards. Results1.1 Eighty-three patients with lumbar disc herniation received an injection of medical ozone into discs and paravertebral spaces. According to the diagnosis standard of lumbar disc infection, none of these patients showed any signs of infection by physical examinations, instrumental examinations and laboratory examinations, and there were no extraordinary discomfort after 3 to 6 months' follow-up. During the time, all patients had normal temperature, and did not complain about any complications such as haematoma, exudation, hot and pain on the site of puncture, or muscles pain and no pressure pain of lumbar.1.2 Laboratory examinations showed the changes of WBC, NEU% and CRP in the study, and there were no significant differences statistically concerning the above values exceeding normal standards between the three groups. ConclusionsIt is not necessary to use antibiotics to prevent infections during the peri-procedure of percutaneous intradiscal ozone-injection to treat lumbar disc heriniation. Part 2 Percutaneous Drug Injection, Percutaneous Biopsy and DrainageObjectiveTo investigate prospectively the feasibility of without antibiotic prophylaxis usage in the period of peri-procedure of percutaneous drug injection, percutaneous biopsy, percutaneous drainage of chest and abdomen through a randomized method and to analyze the risk factors of infection under the condition. Materials and MethodsForty-one patients, whose temperature and three routine examinations and CRP were all normal, were divided into two groups at random. Of the 41 patients, 27 underwent percutaneous drug injection, 9 cases percutaneous biopsy, and 5 cases percutaneous drainage of chest or abdomen. Prophylaxis group (22 cases) were injected with Cephalothin V 2.0g intravenously within 30 minutes before the procedure. The contrast group (19 cases) did not receive any antibiotics. The patients were followed up for armpit temperature, WBC count, CRP and body signs after the procedures. The diagnosis criteria of infection according to Diagnostic Criteria for Hospital Infection. Statistical analysis was done between two groups with the value of WBC and NEU% and CRP above the standards. Results1.1 Percutaneous drug injection, biopsy and drainage of chest or abdomen were carried out in 41 patients. Post-procedure pyrexia was found in 13 cases. One patient with FNH diagnosed before procedure had a continuous high fever of 39.5 °C after TACE and biopsy. The temperature did not decrease by allopathy untilantibiotics was used. So she was suspicious of infection. The other patients with fever did not conform to the diagnosis criteria of hospital infection. Pyrexia occurred in 8 of 22 patients who had percutaneous injection of drugs into the tumors, 3 of 5 patients after TACE and percutaneous intra-lesion injection of chemicals, and 2 of 5 patients after TACE and biopsy. No pyrexia or discomfort was found in the four patients who were subjected to biopsy alone and 5 patients treated by percutaneous drainage of chest or ascites. Some of the patients during the procedure had bellyache on the location of puncture site, but without peritoneum activate syndrome, and mostly disappearing in three days; In addition, no other complications were found in these patients, such as haematoma, heat, exudation on the site of puncture, and no muscle pain and pressure pain were presented.1.2 WBC, NEU% and CRP were observed to have changed by laboratory examinations in the study, and there were no significant differences statistically concerning the above values exceeding normal standards between the two groups. ConclusionsIt is not necessary to use antibiotics to prevent infections during the peri-procedure of percutaneous drug injection, percutaneous biopsy and percutaneous chest or abdomen drainage.