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

Negm, AA; Schott, Anja; Vonberg, Ralf‐Peter; Weismueller, Tobias J.; Schneider, Andrea; Kubicka, Stefan; Strassburg, Christian P.; Manns, Michael P.; Suerbaum, Sebastian; Wedemeyer, Jochen; Lankisch, Tim O.

doi:10.1016/j.gie.2010.02.043

Cited by 106 publications

(108 citation statements)

References 21 publications

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“…Aerobic bacteria, such as Escherichia coli, Klebsiellapneumoniae, Enterococcus spp., and Enterobacter, are most frequently isolated (8,13,15,(20)(21)(22). The results of our study support this finding.…”

Section: Discussionsupporting

confidence: 89%

“…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).…”

Section: Discussionmentioning

confidence: 99%

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

Suna

Yıldız²,

Yüksel³

et al. 2014

Turk J Gastroenterol

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Background/Aims: Infection in the bile tract is a major cause of bacteremia and is related to high morbidity and mortality. We examined the changes in bacteria types and antibiotic susceptibility in bile cultures and simultaneous blood cultures taken from patients who applied for endoscopic retrograde cholangio pancreatography (ERCP)/ percutaneous transhepatic cholangiography (PTC) for different bile duct diseases in recent years. Materials and Methods: Bacteria types that reproduce in bile and blood cultures from patients who applied for ERCP/PTC between the years of 2007 and 2012 in our clinic were examined. All patients were evaluated together, and in addition, the periods between 2007 and 2009 (Group 1) and between 2010 and 2012 (Group 2) were compared. Results: In total, 550 patients applied to this study. There were 266 patients in Group 1 and 284 in Group 2. Reproduction occurred in 77.6% of bile cultures. In the order of frequency, these cultures consisted of Escherichia coli (32.8%), Enterococcus spp. (26.2%), and Pseudomonas aeruginosa (11%). Enterococcus spp. were determined to be higher in Group 2 than Group 1 (p<0.016). Resistance to quinolones was found in 74.1% of patients, to ampicillin in 73.2%, and to cephalosporins in an average of 61%. Vancomycin was the most susceptible antibiotic (93.4%) to gram-positives. Resistance to piperacillin-tazobactam and amikacin was higher in Group 2 than Group 1 (p=0.001 and p=0.003, respectively). Conclusion:The most frequently reproducing bacteria in the bile cultures evaluated in our hospital were Escherichia coli and Enterococcus spp. Although it was thought that the antibiotics given empirically were effective against these bacteria, there was resistancerate of 75% in our study. We determined that the first-and second-step treatment protocols must be updated.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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

Suna

Yıldız²,

Yüksel³

et al. 2014

Turk J Gastroenterol

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“…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.…”

Section: Discussionsupporting

confidence: 87%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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Background:Immunosuppression, denervation of biliary tract, and presence of biliary strictures favor colonization of bile with microorganisms after liver transplantation. Little is known about spectrum and antibiotic susceptibility of this colonization. Material/Methods:Bile and feces were collected prospectively from 38 patients who underwent endoscopic retrograde cholangiopancreaticography after liver transplantation. Samples were analyzed for colonization and antibiotic susceptibility. Results:From the 38 tested bile samples, 86.6% tested positive. Of those, 26 (78.8%) were polymicrobial. Of isolated bile samples, 52 (64.2%) were gram-positive, 22.2% were gram-negative, and 13.6% revealed Candida albicans. Most detectable gram-positive bacteria were Enterococcus faecium. Most detectable gram-negative bacteria were E. coli and Klebsiella pneumonia. Our analyses revealed high resistance rates of the isolates. Only 55.6% of isolates were sensitive to ciprofloxacin, 54% were sensitive to piperacillin/tazobactam, and 60.3% were sensitive to imipenem. High susceptibility rates were found for linezolid and vancomycin (72.9% and 72.6%, respectively). We found a high correlation between microorganisms found in bile and those isolated from stool. Conclusions:Bile of liver transplant recipients is frequently colonized with microorganisms. The starting point of this colonization is usually the intestine. Systematic analysis of bile colonization during endoscopic interventions on biliary tracts of liver transplant recipients might help to select effective prophylactic antibiotic regimes as well as to facilitate the choice of suitable antimicrobial therapy in case of septic complications.

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“…Several clinical risk factors have been described that are associated with the reduced transplantation-free survival, e.g. dominant strictures and concomitant immunological diseases or biliary infections [17][18][19]. In addition to bacterial infections, some studies suggested a strong influence of fungal infections on the survival of PSC patients [20,21].…”

Section: Introductionmentioning

confidence: 99%

Risk factors and outcome in patients with primary sclerosing cholangitis with persistent biliary Candidiasis

Rupp¹,

Chahoud²,

Bode³

et al. 2014

Z Gastroenterol

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

Cited by 106 publications

References 21 publications

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

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

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

Risk factors and outcome in patients with primary sclerosing cholangitis with persistent biliary Candidiasis

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