The effect of oral decontamination with clindamycin palmitate on the incidence of bacteremia after esophageal dilation: a prospective trial

• Published in: Gastrointestinal endoscopy Vol. 50; no. 4; pp. 475 - 479
• Main Authors: Hirota, William K., Wortmann, Glenn W., Maydonovitch, Corinne L., Chang, Audrey S., Midkiff, Russell B., Wong, Roy K.H., Moses, Frank M.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.10.1999; Elsevier
• Subjects: Aged; Anti-Bacterial Agents - administration & dosage; Antibiotic Prophylaxis; Bacteremia - microbiology; Bacteremia - prevention & control; Bacteria - isolation & purification; Biological and medical sciences; Clindamycin - administration & dosage; Digestive system; Dilatation - adverse effects; Dilatation - instrumentation; Esophageal Stenosis - therapy; Female; Humans; Male; Medical sciences; Middle Aged; Mouth - microbiology; Mouthwashes; Pharmacology. Drug treatments; Prospective Studies; Single-Blind Method; Human; Evaluation; Clindamycin; Esophageal disease; Oral administration; Stenosis; Instrumental dilatation; Bacteremia; Incidence; Esophagus; Infection; Antibiotic; Randomization; Decontamination; Efficiency; Aminoglycoside; Bacteriosis; Digestive diseases; Antibacterial agent; Comparative study
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(99)70068-4

Background:  Antibiotic prophylaxis to prevent bacterial endocarditis is recommended in high-risk patients undergoing esophageal dilation, a high-risk procedure. Some studies suggest that the oropharynx is the source of bacteremia. A topical antibiotic mouthwash, which reduces bacterial colonization of the oral flora, might decrease bacteremia rates and would be an attractive alternative to systemic administration of antibiotics. Methods:  Adults undergoing outpatient bougienage for a benign or malignant esophageal stricture were randomized in a clinician-blinded fashion to either pre-procedure clindamycin mouthwash or no treatment. Subjects were stratified by type of dilator used. Blood cultures were obtained immediately after the first esophageal dilation and 5 minutes after the last dilation. Results:  Fifty-nine patients were enrolled: 30 in the treatment arm and 29 in the no-treatment arm. There were 7 positive blood cultures: 5 in the treatment arm and 2 in the no-treatment arm. The identified organisms were Streptococcus viridans (2), Staphylococcus mucilaginous (2), Lactobacillus (2), and Actinomyces odontolyticus (1). Patients with bacteremia reported greater subjective difficulty with dysphagia ( p = 0.01) irrespective of stricture diameter, procurement of biopsies, or dilator type. Conclusions:  The percentage of cases with bacteremia for all dilations performed in this manner was 12% (95% CI [5.3, 23.6]), much lower than previously cited. All organisms in this study were oral commensals. There appears to be no effect of a clindamycin mouthwash on reducing bacteremia after esophageal dilation. (Gastrointest Endosc 1999;50:475-9.)