Assessing the effect of single dose antibiotic prophylaxis compared with a multiday regimen in liver transplant recipients undergoing routine endoscopic retrograde cholangiopancreatography: a retrospective, single-centre, registry-based cohort study with a historical control group

Objective Biliary complications, particularly anastomotic strictures, are common after liver transplantation (LT). The recommended duration of antibiotic prophylaxis after routine endoscopic retrograde cholangiopancreatography (ERCP) for LT patients varies across international guidelines and literature. Therefore, this study aimed to evaluate the impact of a single-dose antibiotic prophylaxis on the post-ERCP cholangitis rate, overall antibiotic exposure and potential risk factors for cholangitis in this cohort. Methods We conducted a single-centre, registry-based, non-interventional cohort study at the Department of Gastroenterology, Heidelberg University Hospital, to investigate the impact of a newly introduced standard operating procedure (SOP) involving a periinterventional single-dose prophylaxis (SOP cohort, n=54 procedures) compared with a historical cohort (n=100 procedures) that received a multiday regimen. Following its implementation in January 2019, the SOP cohort included all routine ERCPs from January 2019 to May 2020, whereas the historical cohort comprised procedures from March 2015 to August 2017. The diagnosis and severity grading of cholangitis were based on the adapted Tokyo Guidelines. Results The duration of the periinterventional antibiotic therapy differed significantly between cohorts, with a median of 0.33 days in the SOP cohort and 4 days in the historical cohort (p<0.001). Despite this reduction, there was no significant difference in the rate of post-ERCP cholangitis between the two cohorts (without dilation: 9.5% vs 17.4%, p=0.67)—even in procedures involving dilation (20.3% vs 25.8%, p=0.53). Moreover, univariate analysis did not identify any significant risk factors for the development of post-ERCP cholangitis, including the performance of dilation (p=0.32). Conclusion In our study, a significant reduction in periinterventional antibiotic duration did not increase post-ERCP cholangitis risk, even with dilation. This suggests shorter regimens can be safely implemented.