Bactobilia after liver transplantation: Frequency and antibiotic susceptibility

Abstract

After liver transplantation (LT), bactobilia occurs frequently in patients, leading in some cases to cholangitis and biliary sepsis. The present study is the first to investigate bactobilia after LT, and it gives an overview of predisposing factors for bactobilia, the microbial spectrum in the bile of LT patients, and the antibiotic susceptibility. A total of 172 endoscopic retrograde cholangiography (ERC) procedures were performed in 66 LT patients between 1 month and 5.8 years after LT. Bile samples were examined microbiologically. Sixty-eight nontransplanted patients without cholestasis, but requiring ERC for other reasons served as a control group. Of 172 samples obtained from LT patients, 126 (73.3%) were positive for microbes. A total of 236 organisms were isolated: 114 (48.3%) gram-positive bacteria, 92 (39.0%) aerobic gram-negative, 8 (3.4%) anaerobes, and 22 (9.3%) fungi. Ciprofloxacin and amoxycillin/clavulanic acid showed the best susceptibility results among oral antibiotics and piperacillin/tazobactam and imipenem/cilastatin among intravenous preparations. In contrast, only 15.7% of non-LT patients showed bactobilia. In conclusion, our study shows that bactobilia is a problem in patients after LT and that it is not only a contamination from endoscopic intervention. Mechanical obstruction, plastic stents, gallstones, and papillotomy increase the risk of bactobilia significantly. In our cohort we had the best antibiotic susceptibility results for positive cultures in LT patients with piperacillin/tazobactam, ciprofloxacin, or amoxycillin/clavulanic acid. Liver Transpl 12:747-753, 2006.

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

“…Most common isolates were Enterococcus species, whereas, in the non-transplant setting, more gram-negative bacteria, especially E. coli and klebsiella, are found [18][19][20][21]. Our results confirm former studies that showed a shift in microbial spectrum in bile of immunosuppressed patients after LT towards gram-positive bacteria with a markedly increased incidence of Enterococci [8][9][10]. Those findings emphasize the relevance of analysis of bile isolates in liver transplant recipients with regard to the spectrum and resistogram to select an effective antibiotic prophylaxis for these patients and also to treat potential septic complications after ERCP in liver transplant patients.…”

“…In 2006 Millonig et al found resistance rates to ciprofloxacin, piperacillin / tazobactam, and imipenem of only 19-32% of bacteria isolated from bile of liver transplant recipients [9]. These resistance rates are lower than those demonstrated in our study.…”

“…Although bile is sterile in healthy individuals [6,7], bactibilia is frequently found in patients after LT. Additional risk factors for colonization of bile include the presence of foreign bodies such as stones and stents [8,9].…”

The change in microorganisms reproducing in bile and blood culture and antibiotic susceptibility over the years

“…This reproduction rate was not surprising because contamination of the biliary system is well-known in patients who have sphincterotomy or a placed stent. In past studies, 16%-85% reproduction was determined (4,(8)(9)(10)(11)(12)(13)(14). In older studies, 30%-90%polymicrobial reproduction in bile cultures was determined, especially in patients whose bile ducts had previous interference (15)(16)(17)(18)(19).…”

Routine bile collection for microbiological analysis during cholangiography and its impact on the management of cholangitis

“…Other studies detected bacteriobilia in 16% to 82% of patients, depending on different disease groups. 8,[13][14][15] Risk factors of bacteriobilia include OLT, steroid treatment, biliary stenting, and repeated biliary interventions. Biliary stenting is associated with bacteriobilia because stenting of the common bile duct remains a cause of ascending cholangitis.…”