Analysis of Bile Colonization and Intestinal Flora may Improve Management in Liver Transplant Recipients Undergoing ERCP

Kabar, Iyad; Hüsing, Anna; Cicinnati, Vito R.; Heitschmidt, Laura; Beckebaum, Susanne; Thölking, Gerold; Schmidt, Hartmut; Karch, Helge; Kipp, Frank

doi:10.12659/aot.893549

Cited by 12 publications

(6 citation statements)

References 21 publications

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“…Several studies have identified LT as a risk factor for increasing microbial colonization of bile. In these studies, an increased incidence of gram-positive bacteria with increasing antibiotic resistance, such as enterococci and Candida species, in patients with LT was found[26-29]. In our study, we found a remarkably high prevalence of Candida species (39.1%), whereas the prevalence of enterococci was 29.7%.…”

Section: Discussionsupporting

confidence: 58%

Single-operator cholangioscopy for biliary complications in liver transplant recipients

Hüsing‐Kabar¹,

Heinzow²,

Schmidt³

et al. 2017

WJG

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AIMTo evaluate cholangioscopy in addition to endoscopic retrograde cholangiopancreatography (ERCP) for management of biliary complications after liver transplantation (LT).METHODSTwenty-six LT recipients with duct-to-duct biliary reconstruction who underwent ERCP for suspected biliary complications between April and December 2016 at the university hospital of Muenster were consecutively enrolled in this observational study. After evaluating bile ducts using fluoroscopy, cholangioscopy using a modern digital single-operator cholangioscopy system (SpyGlass DS™) was performed during the same procedure with patients under conscious sedation. All patients received peri-interventional antibiotic prophylaxis and bile was collected during the intervention for microbial analysis and for antibiotic susceptibility testing.RESULTSThirty-three biliary complications were found in a total of 22 patients, whereas four patients showed normal bile ducts. Anastomotic strictures were evident in 14 (53.8%) patients, non-anastomotic strictures in seven (26.9%), biliary cast in three (11.5%), and stones in six (23.1%). A benefit of cholangioscopy was seen in 12 (46.2%) patients. In four of them, cholangioscopy was crucial for selective guidewire placement prior to planned intervention. In six patients, biliary cast and/or stones failed to be diagnosed by ERCP and were only detectable through cholangioscopy. In one case, a bile duct ulcer due to fungal infection was diagnosed by cholangioscopy. In another case, signs of bile duct inflammation caused by acute cholangitis were evident. One patient developed post-interventional cholangitis. No further procedure-related complications occurred. Thirty-seven isolates were found in bile. Sixteen of these were gram-positive (43.2%), 12 (32.4%) were gram-negative bacteria, and Candida species accounted for 24.3% of all isolated microorganisms. Interestingly, only 48.6% of specimens were sensitive to prophylactic antibiotics.CONCLUSIONSingle-operator cholangioscopy can provide important diagnostic information, helping endoscopists to plan and perform interventional procedures in LT-related biliary complications.

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Section: Discussionsupporting

confidence: 58%

Single-operator cholangioscopy for biliary complications in liver transplant recipients

Hüsing‐Kabar¹,

Heinzow²,

Schmidt³

et al. 2017

WJG

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“…Importantly, colonization by enteric bacteria, despite successful endoscopic treatment, and fungibilia were associated with lower retransplantation-free survival. Later, the composition of the bile microbiome by was confirmed culture-based techniques by a smaller prospective study [144]. Only in the studies by Liu et al [145,146] was the bile microbiota assessed by 16S-rRNA gene sequencing.…”

Section: Faecalibacterium Lachnospiramentioning

confidence: 92%

“…Finally, only a handful of studies has evaluated the composition of the bile microbiome in LT recipients, exclusively in patients undergoing ERCP/percutaneous transhepatic cholangiography for biliary complications [144]. In a prospective cohort of 213 patients, the authors showed that the most common bacterial isolates were Enterococcus spp.…”

Section: Faecalibacterium Lachnospiramentioning

confidence: 99%

Biliary Diseases from the Microbiome Perspective: How Microorganisms Could Change the Approach to Benign and Malignant Diseases

Binda¹,

Gibiino²,

Coluccio³

et al. 2022

Microorganisms

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Recent evidence regarding microbiota is modifying the cornerstones on pathogenesis and the approaches to several gastrointestinal diseases, including biliary diseases. The burden of biliary diseases, indeed, is progressively increasing, considering that gallstone disease affects up to 20% of the European population. At the same time, neoplasms of the biliary system have an increasing incidence and poor prognosis. Framing the specific state of biliary eubiosis or dysbiosis is made difficult by the use of heterogeneous techniques and the sometimes unwarranted invasive sampling in healthy subjects. The influence of the microbial balance on the health status of the biliary tract could also account for some of the complications surrounding the post-liver-transplant phase. The aim of this extensive narrative review is to summarize the current evidence on this topic, to highlight gaps in the available evidence in order to guide further clinical research in these settings, and, eventually, to provide new tools to treat biliary lithiasis, biliopancreatic cancers, and even cholestatic disease.

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“…[19][20][21] Gram-positive bacterial infection has attracted attention recently because it is highly detected in cholangitis of liver transplantation patients. [22][23][24] Mohammed et al showed that the consequences of bacteriobilia can be prevented by pre-operative and postoperative antibiotics that act on the common digestive tract pathogens such as enterobacters and anaerobes. 25 Also, Herzog et al recommended bile cultures during biliary surgeries for better antibiotic sensitivity and prophylaxis from infective complications.…”

Section: Introductionmentioning

confidence: 99%

“…are the most commonly observed gram‐positive microorganisms 19–21 . Gram‐positive bacterial infection has attracted attention recently because it is highly detected in cholangitis of liver transplantation patients 22–24 . Mohammed et al .…”

Section: Introductionmentioning

confidence: 99%

Pattern of bile cultures and antibiotic sensitivity tests in Sudanese patients diagnosed with obstructive jaundice: A single‐center prospective study

Babekir,

Abdelrahim,

Doush

et al. 2023

JGH Open

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Background and Aim Biliary obstruction causes bacteriobilia and significant morbidity and high mortality, which necessitates prompt and effective treatment for a good clinical outcome. Hence, the aim of this study was to determine updated knowledge of biliary microbial spectrum, antibiotic sensitivity pattern, and key clinical factors of bacteriobilia. Methods This is a prospective study conducted during the period between November 2021 and December 2022 at Ibn Sina specialized hospital, Khartoum, Sudan, on 50 patients diagnosed with obstructive jaundice and symptomatic bacteriobilia who underwent open biliary surgeries electively. Bile samples were aspirated intra‐operatively and cultured, and antibiotic sensitivity tests were performed. Results Fifty‐four percent of patients diagnosed with obstructive jaundice who underwent elective open biliary surgeries were males with the ratio (2:1). Forty‐six percent of patients were between 61 and 75 years (elderly). The most frequent cause of obstructive jaundice was migrating biliary stones (48% of cases). Thirty‐two percent of patients were diabetic with bacteriobilia. The predominant isolated bacterial pathogen in this study was Escherichia coli (36% of cases). These biliary pathogens were sensitive to meropenem in 54% of cases and ciprofloxacin in 46%. Eventually, in all patients in this study, biliary bacterial pathogens were found to be resistant to a broad spectrum of antibiotics. Conclusion Careful selection of empirical antibiotic therapy based on surveillance of routine bile cultures during biliary tree procedures in patients with high risk of bacteriobilia will potentially help in improving the surgical outcomes and optimizing treatment of acute cholangitis, which is associated with high mortality.

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Analysis of Bile Colonization and Intestinal Flora may Improve Management in Liver Transplant Recipients Undergoing ERCP

Cited by 12 publications

References 21 publications

Single-operator cholangioscopy for biliary complications in liver transplant recipients

Single-operator cholangioscopy for biliary complications in liver transplant recipients

Biliary Diseases from the Microbiome Perspective: How Microorganisms Could Change the Approach to Benign and Malignant Diseases

Pattern of bile cultures and antibiotic sensitivity tests in Sudanese patients diagnosed with obstructive jaundice: A single‐center prospective study

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