Identification of the risk factors for liver abscess after CT-guided interstitial brachytherapy and the evaluation of intensified antibiotic prophylaxis.

PURPOSE: To identify the risk factors for liver abscess in patients undergoing CT-guided interstitial brachytherapy, and the effectiveness of intensified antibiotic prophylaxis regimen in patients with assumed high-risk.

METHODS

All patients who underwent CT-guided high-dose-rate interstitial brachytherapy of liver lesions between July 2017 and June 2022 at a single center were retrospectively evaluated. Patients with a follow-up shorter than 1 month were excluded. No routine periinterventional antibiotic prophylaxis was used. Patients with assumed risk factors (enterobiliary manipulations, biliary dilatation, central large tumor) were prescribed with 10-day ciprofloxacin and metronidazol, followed by ciprofloxacin for a week every month. Risk factors were identified using multivariable logistic regression and LASSO.

RESULTS

560 patients with 862 interstitial brachytherapy sessions were included. Of 55 patients with risk factors, 42 received antibiotic prophylaxis and 13 did not. The rate of liver abscess was 1.04% (9 of 862 procedures) per procedure and 1.6% (9 of 560 patients) per patient. The rate of hepatic abscess was 0.39% in patients without risk factors. Multivariable analysis and LASSO showed a significant correlation between liver abscess and the presence of biliodigestive anastomosis (p < 0.001) and biliary stent (p < 0.001). The rate of liver abscess in patients with enterobiliary manipulations was 23% (3 of 13) without antibiotic prophylaxis and 11.7% (4 of 34) under antibiotic prophylaxis (p = 0.376).

CONCLUSION

The risk of liver abscess after CT-guided interstitial brachytherapy is extremely low in patients without risk factors. Biliodigestive anastomosis is a risk factor for liver abscess, and intensified antibiotic prophylaxis shows a trend to decrease liver abscess risk.