Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 8, 2015; 7(4): 710-716
Published online Apr 8, 2015. doi: 10.4254/wjh.v7.i4.710
Endotipsitis: A case report with a literature review on an emerging prosthetic related infection
Annalan MD Navaratnam, Matthew Grant, David B Banach
Annalan MD Navaratnam, Department of Infectious Disease Epidemiology, Imperial College London, W2 1PG London, United Kingdom
Matthew Grant, David B Banach, Department of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, United States
Author contributions: Navaratnam AMD and Grant M conceived the idea and drafted the manuscript; Navaratnam AMD carried out the literature review and data collection; Navaratnam AMD, Grant M and Banach DB analyzed the data; all authors revised, read and approved the final manuscript.
Conflict-of-interest: The authors declare that they have no conflict of interests.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Annalan MD Navaratnam, Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Campus, Norfolk Place, W2 1PG London, United Kingdom.
Telephone: +44-20-759443287
Received: August 1, 2014
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.

Keywords: Transjugular intrahepatic portosystemic shunts, Transjugular intrahepatic portosystemic shunt infection, Persistent bacteremia, Tipsitis, Antimicrobial therapy

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.