Analysis Of Risk Factors To Biliary Tract Infection After ERCP Stone Removal For Patients With Choledocholithiasis

Objective: This work aims to retrospectively analyze the risk factors to biliary tract infection after Encoscopic Retrograde Cholangio-Pancreatography(ERCP)stone removal for patients with choledocholithiasis,so as to provide evidence and guide clinical treatment for preventing biliary tract infection after ERCP for Patients with choledocholithiasis.Methods: The data consists of the clinical records of 349 patients who had been diagonsed choledocholithiasis and were treated by means of ERCP stone removal in Affiliated Hospital Youjiang Medical University For Nationalities from January 2014 to December 2017.Firstly,all cases are divided into the infection group and non-infection group based on the diagnostic criteria for biliary tract infection after ERCP.Secondly,analyzing the statistical significance of variables using Single factor regression analysis.The univariate variables include gender,age,Body Mass Index(BMI),diabetes,biliary operation history,smoking history,White Blood Cell(WBC),Hemoglobin(HGB),Total bilrubin(TBIL),Albumin(ALB),Alanine transaminase(ALT),Carbohydrate Atigen 199(Ca199),Triglyceride(TG),preoperative hospitalization days,operation time,Oddis sphincterotomy and prophylactic use of antibiotics.Thirdly,multivariate analysis is adopted on significant variables.Finally,determining the risk factors and independent risk factors to biliary tract infection after ERCP stone removal for patients with choledocholithiasis through the above analysis.Results: Among the 349 patients who have complete clinical data,38 of them are infection group and 311 of them are non-infection cases.It means that the infection rate was 10.89%.The Single factor regression analysis showed that risk factors for biliary tract infection after ERCP includes age(P=0.023),BMI index(P=0.018),diabetes(P=0.021),preoperative hemoglobin level(P=0.005),preoperative albumin level(P < 0.001),operation time(P=0.007),non-prevention of using of antibiotics(P < 0.001),Oddis sphincterotomy(P=0.027).However the following factors whose P values are greater than 0.05 do not have much relation to recurrence of common bile duct stones,includes: sex(P=0.133),biliary operation history(P=0.448),smoking history(P=0.590),WBC(P=0.187),TBIL(P=0.777),ALT(P=0.099),Ca199(P=0.448),TG(P=0.631)and preoperative hospitalization(P=0.767).Multivariate analysis result showed that diabetes(P=0.028,OR=3.648),preoperative hemoglobin level(P=0.028,OR=2.584),preoperative albumin level(P<0.001,OR=8.297),operation time(P=0.003,OR=4.518)and non-prophylactic use of antibiotics(P<0.001,OR=10.577)present significant difference.It means that these five factors play particularly important role in biliary tract infection after ERCP stone removal.Conclusion: Age,BMI,diabetes,preoperative hemoglobin level,preoperative albumin level,prevention of use of antibiotics,operation time,and Oddis sphincterotomy were risk factors for choledocholithiasis after ERCP stone removal.And diabetes,preoperative hemoglobin level,preoperative albumin level,operation time and non-prophylactic use of antibiotics were independent risk factors.