Post-procedural antibiotic use does not significantly affect infectious complication rates following uterine fibroid embolization (UFE), a recent pilot study concludes. Presenting these data at the Global Embolization Oncology Symposium Technologies (GEST; 9–12 May, New York, USA), Omar Chohan (Christiana Care Health System, Newark, USA) told attendees that, in the small study group under investigation, foregoing post-treatment antibiotics did not result in an increased rate endomyometritis.
However, Chohan acknowledges that the cohort is under-powered to demonstrate non-inferiority of the study group, and thus believes that the present pilot study serves as a model for a larger scale study evaluating the necessity of post-UFE antibiotics.
Chohan and colleagues set out to evaluate the necessity of prophylactic post-procedural administration of antibiotics after UFE in the prevention of procedure-related infections. According to Chohan, current guidelines from the Society of Interventional Radiology (SIR) report limited data regarding antibiotic use and state that prophylaxis is at the “discretion of the treating hospital”, though preprocedural antibiotic use is recommended. Cohan also informs GEST delegates that, as cited in multiple studies, the role of post-procedural prophylactic antibiotic treatment is controversial. “There has been no study confirming whether we need it or not”, Chohan claimed.
The study investigators therefore conducted polling of 92 academic interventional radiology practices in the USA to determine whether or not they used post-procedural antibiotics following UFE. Of 27 responses, ten did and seventeen did not. Of the ten centres that did use post-procedural antibiotics, one used Levaquin/ Flagyl, seven used Ciprofloxacin, and two used Doxycycline.
Following this survey, Chohan and colleagues conducted their pilot study. Two-hundred-and-ninety-three patients undergoing UFE at a single community centre between June 2014 and June 2018 were enrolled in a retrospective cohort study, and divided into a control group and a treatment group. In the control arm, 144 patients were given both preprocedural and post-procedural antibiotics (the latter being oral Ciprofloxacin and 500mg BID over seven days). Meanwhile, the 149 patients in the study group were only given preprocedural antibiotics. There were no significant differences regarding patient demographics or procedure details between the two groups.
In adherence with the SIR guidelines, Chohan and colleagues administered a single dose of pre-procedural antibiotics to all patients. The primary endpoint of the study was infection rate (endomyometritis) within 90 days of the procedure. Embolization was performed using either Embospheres (Merit Medical) or Embozene (Boston Scientific). Ninety-day follow-up data were collected.
The difference in infection rates between the two groups was not statistically significant (p=1): one patient (0.7%) in the post-procedure antibiotic group had sepsis nine days after UFE and was treated with hysterectomy; two patients (0.7%) in the study arm had malodorous discharge at 10 and 15 days, respectively, after the treatment, and were subsequently treated with antibiotics.
Contextualising these findings, Chohan said at GEST that most major and minor infectious complications present within the first month following UFE. Minor complications, he commented, which occur in 0.2–5.9% of patients, often do not necessitate hospitalisation, the intravenous administration of antibiotics, or surgical intervention. Major infectious complications include pelvic abscesses (experienced by 0.3% of patients), septicaemia, and emergency myomectomy or hysterectomy (reported in 1.2–2.6% patients).
Chohan argues that this research is timely and important, given the global conversation regarding the risks of over prescribing antibiotics. He commented: “I think the standard of not using those post-procedural antibiotics makes sense, because otherwise you are giving patients an antibiotic that might alter their gut bacteria or you may inadvertently be increasing antibiotic resistance”.