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

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 and 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.

Titel: Analysis of Bile Colonization and Intestinal Flora may Improve Management in Liver Transplant Recipients Undergoing ERCP
Verfasser: Kabar, Iyad GND
Hüsing, Anna Katharina Elisabeth Pia GND
Cicinnati, Vito R.
Heitschmidt, Laura GND
Beckebaum, Susanne GND
Thölking, Gerold Bernhard GND
Schmidt, Hartmut GND
Karch, Helge GND
Kipp, Frank GND
Organisation: FB 05: Medizinische Fakultät
Dokumenttyp: Artikel
Medientyp: Text
Erscheinungsdatum: 04.05.2015
Publikation in MIAMI: 01.06.2015
Datum der letzten Änderung: 01.06.2015
Quelle: Annals of Transplantation 20 (2015), 249-255
Schlagwörter: Bile Duct Diseases; Cholangiopancreatography; Endoscopic Retrograde; Liver Transplantation
Fachgebiete: Medizin und Gesundheit
Lizenz: CC BY-NC-ND 4.0
Sprache: Englisch
Anmerkungen: Finanziert durch den Open-Access-Publikationsfonds 2014/2015 der Deutschen Forschungsgemeinschaft (DFG) und der Westfälischen Wilhelms-Universität Münster (WWU Münster).
Format: PDF-Dokument
URN: urn:nbn:de:hbz:6-69249637696
DOI: 10.12659/AOT.893549