Published online Apr 8, 2015. doi: 10.4254/wjh.v7.i4.710
Peer-review started: August 2, 2014
First decision: November 14, 2014
Revised: December 15, 2014
Accepted: January 30, 2015
Article in press: February 2, 2015
Published online: April 8, 2015
AIM: To investigate the etiology and management of a poorly understood complication of transjugular intrahepatic portosystemic shunt; “endotipsitis”.
METHODS: A MEDLINE database search was carried out, reviewing all papers with specific words in the title or abstract, and excluding appropriately. Of 283 papers that were reviewed, 22 papers reporting 53 cases in total were included in the analyses.
RESULTS: No predominant etiology for endotipsitis was identified, but gram-positive organisms were more common among early-onset infections (P < 0.01). A higher mortality rate was associated with Staphylococcus aureus and Candida spp infections (P < 0.01). There was no trend in choice of antibiotic based on the microorganisms isolated and treatment varied from the guidelines of other vegetative prosthetic infections. In endotipsitis “high risk” organisms have been identified, emphasizing the importance of ensuring optimal antimicrobial therapy and adjunctive management strategies.
CONCLUSION: Higher mortality rate was associated with Staphylococcus aureus and Candida spp infections. A prospective multicenter trial is needed before specific treatment can be recommended.
Core tip: We present a case of a rare disease entity called endotipsitis, vegetative infection of a transjugular intrahepatic portosystemic shunt (TIPS). This case has the longest latency, from insertion to infection, reported in the literature. The literature review supplementing this case report demonstrates an association between onset of infection from TIPS insertion and the etiological agent causing the disease. Furthermore, we demonstrate significantly poorer outcomes in specific infections.