Study On Microbial Profiles And Risk Factors Of Biliary Infection In Patients With Therapeutic Endoscopy

BACKGROUND: The biliary disorders are common within the gastroenterology society and they might cause biliary obstruction and trigger the infection consequently.To determine the microbial profiles of the biliary infection is significant,especially for the treatment managements.Endoscopic retrograde cholangiopancreatography(ERCP)has gradually become an indispensable procedure in the diagnosis and treatment of many pancreaticobiliary diseases.However,the bile infection may already exist before the administration of an interventional procedure,despite no clinical manifestations of cholangitis detected.Currently there still lack of relevant researches relatively in large samples.Risk factors associated with bacterial growth in bile before the intervention are not well defined.AIM: To establish the bacterial profiles isolated from the bile samples,and to identify distributions as well as risk factors for bacterial colonization in the bile system.METHODS: Individuals who had various biliary or pancreatic disorders and underwent Endoscopic retrograde cholangiopancreatography(ERCP)interventions between January 2012 and August 2018 were enrolled and retrospectively analyzed.Bile samples of approximately 4 mL volume were aspirated and were immediately transferred into a sterile tube for storage and cultivation.Further study to identify distributions as well as risk factors for bacterial colonization in the bile system.RESULTS: Positive bile cultures were detected in 281(37.2%)of 755 patients,including 254 benign diseases and 27 malignances.Of 281 positive cases,275(97.9%)were mono-infection and 6(2.1%)multi-infection.Escherichia coli were the most common Gram-negative bacteria(58.9%),followed by Klebsiella pneumoniae(12.2%).Enterococcus faecalis represented the most common Gram-positive microorganism(6.6%),while Candida albicans(2.1%)were the dominant fungi.Klebsiella pneumoniae were more frequently detected in malignant diseases(P<0.05).Age,previous ERCP history,Peripapillary diverticula and CBD diameter were independent risk factors for positive cultures(P<0.05).CONCLUSIONS: Mono-microbial infection was dominant among all infections,and Escherichia coli strains were the most common ones.Klebsiella pneumoniae strains were more frequently isolated from patients with malignant diseases.Age,previous ERCP history,Peripapillary diverticula and CBD diameter were independent risk factors for positive cultures.Bile samples should be collected for culture to confirm potential infection whenever possible as it may lead to more accurate selection and tailoring of antibiotics for the treatment of cholangitis and management of the outcomes of these pancreaticobiliary diseases.To effectively manage patients who are at high risk for bile infection,a detailed diagnosis and treatment plan for each case should be prepared.