Medical management in IR​

Medical management in Vascular and Interventional Radiology (adults)

Post by :- Dr. Ali Asgar Sabir

In the realm of interventional radiology (IR), the use of prophylactic antibiotics has been a subject of investigation, yet the absence of multicenter randomized trials presents a challenge in determining their clinical efficacy and indications. Existing publications exhibit limitations such as reliance on retrospective analyses, variations in patient selection, and definitions of infectious complications, along with the absence of systematic long-term efficacy assessment.

While randomized controlled trials are lacking, antibiotic prophylaxis has become a common practice in selected procedures within IR. Given the lack of definitive scientific validation, recommendations provided here are intended to guide practice rather than enforce specific algorithms. Individual patient factors, procedure type, pathogens, and timing of the most recent antibiotic dose should be closely considered by interventional radiologists.

Procedure Classification	Classification	Infection Risk Factors	Common Organisms	Key Considerations	Routine Prophylaxis	Common Antibiotics
Vascular Interventions	Clean	-	Staphylococcus aureus, Staphylococcus epidermidis	Clean procedures involve no entry into tracts or inflammation.	Generally not recommended	Consider 1 g cefazolin IV in high-risk scenarios. Vancomycin or clindamycin for penicillin-allergic patients.
Endograft Placement	Clean	-	S. aureus, S. epidermidis	Routine antibiotic prophylaxis is common for aortic endograft therapy.	Yes, Routine prophylaxis is common despite limited evidence.	1 g cefazolin IV, or alternates for penicillin-allergic patients.
Superficial Venous Insufficiency Treatment	Clean	-	S. aureus, S. epidermidis	No routine antibiotic prophylaxis for endovascular thermal ablation.	No, No evidence supports routine prophylaxis.	-
IVC Filter Placement	Clean	-	-	Infection post IVC filter placement is rare.	-	-
Central Venous Access	Clean	-	Staphylococcus species	Controversial use of antibiotic prophylaxis for catheter placement.	-	-
Embolization and Chemoembolization	Clean	-	Skin pathogens, Gram-negative organisms	Embolization associated with transient bacteremia.	-	Adjust based on clinical context.
Uterine Artery Embolization	Clean	Low risk	S. aureus, S. epidermidis, Streptococcus species, E. coli	Risk of infection low but reported.	Routine prophylaxis debated; consider antibiotic choice for risk.	1 g cefazolin IV or others.
TIPS	Clean	Periprocedural sepsis risk debated.	-	TIPS stent infection is rare but serious.	-	Ceftriaxone or ampicillin/sulbactam
Gastrostomy Tube Placement	Clean	-	S. aureus, S. epidermidis	"Pull" placement technique associated with peristomal infections.	Yes for "pull" technique	Cefazolin or others.
Biliary Drainage	Contaminated	Advanced biliary disease	Enterococcus, Gram-negative rods	Biliary tract considered contaminated in disease settings	Common	Third-gen cephalosporins, ampicillin/sulbactam, ceftriaxone.
GU Tract Procedures	Clean-contaminated; Contaminated	Age, Diabetes, Bladder dysfunction, etc.	Gram-negative rods (E. coli, Proteus, Klebsiella), Enterococcus	Infection risk higher in obstructed systems.	Recommended	Cefazolin, ceftriaxone, ampicillin/sulbactam
Tumor Ablation	Clean	Hepatic RF ablation, Bilioenteric communication	-	Recommended for hepatic ablation	Controversial; consider antibiotic for high-risk scenarios.	Ampicillin/sulbactam, varies
Percutaneous Abscess Drainage	Dirty	-	Skin flora, Intracavitary pathogens, Gram-negative bacteria, Anaerobes	-	Recommended	Cefoxitin, cefotetan, ceftriaxone, ampicillin/sulbactam
Percutaneous Biopsy	Non-transrectal - Clean; Transrectal - Contaminated	-	Transrectal: Gram-negative bacteria, Enterococcus	Antibiotic prophylaxis typically not needed for non-transrectal biopsies.	Yes (Transrectal); No (Non-transrectal)	Gentamicin + ciprofloxacin or oral ciprofloxacin

Surgical wounds are classified as clean, clean-contaminated, contaminated, and dirty, each associated with varying infection risks.

Clean procedures involve no entry into tracts or inflammation (e.g., routine angiography).
Clean-contaminated procedures enter tracts without inflammation (e.g., nephrostomy tube in sterile urine).
Contaminated procedures involve entry into colonized tracts without pus.
Dirty procedures involve entry into infected sites.

References