Microbial Profiles and Risk Factors of Preexisting Biliary Infection in Patients with Therapeutic Endoscopy

Abstract

Background. The bile infection may already exist before the administration of an interventional procedure, despite no clinical manifestations of cholangitis detected. Blood cultures remained negative even in more than half of the febrile cases with cholangitis. Risk factors associated with bacterial growth in bile before the intervention are not well defined. To establish the bacterial profiles isolated from the bile samples and to identify risk factors for bacterial colonization in the bile system. Methods. Individuals who underwent endoscopic retrograde cholangiopancreatography (ERCP) interventions were enrolled. Bile samples were aspirated and were immediately transferred into a sterile tube for storage. Results. Positive bile cultures were detected in 363 (38.0%) of 956 patients, including 322 benign diseases and 41 malignances. Of 363 positive cases, 351 (96.7%) were monoinfection and 12 (3.3%) multi-infection. Escherichia coli were the most common Gram-negative bacteria (210, 56.0%), followed by Klebsiella pneumoniae (45, 12.0%). Enterococcus faecalis represented the most common Gram-positive microorganism (19, 5.07%), while Candida albicans (11, 2.93%) were the dominant fungi. Klebsiella pneumoniae were more frequently detected in malignant diseases (P=0.046). Age, previous ERCP history or OLT history, and CBD diameter were independent risk factors for positive cultures (P<0.05) while preoperative jaundice drug therapy was the protective factor for bile infection (P<0.05). Conclusion. Monomicrobial infection was dominant among all infections, and Klebsiella pneumoniae strains were more frequently isolated from patients with malignant diseases. To effectively manage patients who are at a high risk for bile infection, a detailed diagnosis and treatment plan for each case should be prepared.

Bile Microbiota in Liver Transplantation: Proof of Concept Using Gene Amplification in a Heterogeneous Clinical Scenario

“…The presence of microbiome in the biliary tree in non-pathological conditions is still controversial. Previous studies in the literature evaluated the bile composition in animals model or in patients with biliary tree diseases (in cholangitis, acute cholecystitis, and cholangiocarcinoma and presence of gallstone) using mostly ERCP to collect bile samples ( 3 , 20 , 21 ). The presence of a biliary induced pathological condition and the use of ERCP were the main limitations of these studies: indeed, Mahafzah et al demonstrated that ERCP was an independent factor associated with positive bile culture ( 22 ).…”

Developing a risk prediction model for multidrug-resistant bacterial infection in patients with biliary tract infection

“…There is therefore a critical need to identify, at the bedside, which patients are at high risk for infection with multidrug-resistant pathogens, so that initial empiric therapy can be targeted at these patients without adversely affecting the rest of the patients with BTI. Unfortunately, many previous studies[ 6 7 12 13 ] have only identified a few risk factors that lead to multidrug-resistant bacterial infections in BTI patients, but no model has been constructed to predict the probability of multidrug-resistant bacterial infections in individual patients. We used a nomogram to build a simple, convenient and repeatable bedside prediction tool which predicts multidrug-resistant bacteria infection and differentiates low versus high risk patients.…”

“…These five predictors are easy to obtain in clinical practice, even in developing countries, indicating that the model has a wide range of application. In the present study, the previous antibiotic use within 90 days and previous biliary surgery were not statistically significant in univariate analysis, but based on clinical experience and prior reports[ 5 6 7 12 13 ] we included these in the multivariate analysis. The results of multivariate analysis showed that previous antibiotic use within 90 days and previous biliary surgery were independent risk factors for multidrug-resistant bacterial infections.…”

“…A study in Korea confirmed that the risk factors for biliary tract infection caused by extended-spectrum beta-lactamase-producing organisms were related to the history of antibiotic use within the previous 90 days, and that the patients at high risk were those who were previously prescribed carbapenems. [ 13 ] Some studies[ 12 16 ] have suggested that patients with a history of a biliary surgery were at increased risk of bacteriobilia, which may be due to these interventions, which change the anatomy of the bile duct, destroy the normal human defense mechanism, decrease the pressure of the bile duct, and may lead to bile reflux. With the reflux of bile increasing, biliary mucosa could experience inflammatory edema, ultimately generating a favorable environment for bacterial proliferation and colonization.…”

Gallbladder Cancer Presenting as Mirizzi Syndrome Complicated by Rapidly Evolving 23 rRNA Gene-Linezolid Resistance with Vancomycin-Resistant Enterococcus Infection Resulting in Fatal Cholangial Sepsis

“…However, cholangitis may be observed as an adverse event after endoscopic retrograde cholangiopancreatography (ERCP) [2] and may delay diagnostic laparotomy or biliary surgery. Enterococci represent one of the three bacteria found most often in the bile fluid of patients with an obstructed bile duct [3]. Antimicrobial treatment of enterococci may be challenging because multidrug-resistant enterococci have been increasingly observed worldwide [4].…”