PROFILE OF BILIARY BACTERIAL CONTAMINATION AND ASSOCIATED MICROBIOLOGICAL OUTCOME AMONG PATIENTS WITH INSTRUMENTED BILIARY SYSTEM UNDERGOING PANCREATICODUODENECTOMY OR HEPATICOJEJUNOSTOMY
Danielle M. Chamberlain*1, Austin B. James2, Alexander Collins2, Frankova Daniela2, Rushin Brahmbhatt1, May C. Tee1, Jan Franko1
1Mercy Hospital Des Moines, West Des Moines, IA; 2Des Moines University College of Osteopathic Medicine, Des Moines, IA
BACKGROUND: Bile duct instrumentation is associated with bacterobilia and infection. We reviewed common bile duct (CBD) intraoperative biliary cultures and associated infections in relation to type of preoperative biliary instrumentation in a community teaching hospital
METHODS: Consecutive cohort of patients during 2009-2018 with a completed pancreaticoduodenectomy or hepaticojejunostomy with available intraoperative bile cultures.
RESULTS: There were 284 intraoperative microbiological isolates among 102 completed cases. Preoperative biliary intervention was classified as non-instrumented (n=32), percutaneous transhepatic cholangiography & drainage (PTC, n=6), ERCP-placed endobiliary stent (n=52), and ERCP intervention without stent (n=12).
There was no age difference between patients with and without preoperative biliary instrumentation (65.8±11.8 vs 62.5±12.9 years, p=0.228) or number of positive postoperative cultures for any indication (1.8±5.3 [range 0-40] vs 0.75±2 [range 0-10], p=0.290).
Preoperative biliary instrumentation was associated with a higher rate of positive CBD culture (3/32 non-instrumented, 9.4% vs 38/70 instrumented, 54.3%; p<0.001) and a higher rate of any postoperative culture for any indication (13/32 non-instrumented, 40.6% vs 53/70 instrumented, 75.7%; p=0.001). Non-instrumented patients had lower number of microbiological isolates from intraoperative cultures of CBD bile (0.1±0.4 [range0-2] vs 2.1±2.9 [range 0-13]; p<0.001).
Type of preoperative biliary intervention was not associated rate of positive intraoperative cultures (3/6, 50% among PTC; 30/52, 57.7% among endobiliary stents; 5/12, 41.7% of preoperative ERCP attempts without stenting; p=0.589). Moreover, proportion of postoperative cultures from any site was not significantly different among various preoperative drainage procedures (p=0.902).
Number of preoperative biliary interventions was not associated with likelihood of positive intraoperative culture (one intervention 22/40, 55.0% vs 16/30, 53.3%; p=0.890) or any postoperative culture (30/40, 75.0% vs 23/30, 76.7%; p=0.872).
There was no association between preoperative biliary intervention and proportion Gram positive, negative and fungal organisms (p=0.856) or their aerobic/anaerobic status (p=0.962). Similarly, number of preoperative biliary interventions was not associated with Gram positive, negative and fungal organisms (p=0.394) or their aerobic/anaerobic status (p=0.174).
Most common isolates were Enterococcus (n=63), Candida (n=50), Klebsiella (n=36), Streptococcus (n-32) and multiresitance was common.
CONCLUSION: Culture-positive microbiome of bile duct is very diverse and often with multiple isolates, especially among patient with any preoperative biliary intervention. Further study will investigate detailed sensitivity/resistance patterns and role of extended antibiotic therapy.
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