Endotipsitis: A case report with a literature review on an emerging prosthetic related infection

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.