Rozhkova Veronika, Tutuş Kamuran, Kömeç Selda, Kınacı Erdem, Bostancı Özgür, Özden İlgin
Department of General Surgery, Liver Transplantation & Hepatopancreatobiliary Surgery Unit, Başakşehir Çam & Sakura City Hospital, Istanbul, Türkiye.
Department of Clinical Microbiology, Başakşehir Çam & Sakura City Hospital, Istanbul, Türkiye.
Front Surg. 2025 Jul 10;12:1538676. doi: 10.3389/fsurg.2025.1538676. eCollection 2025.
Biliary drainage is frequently used in patients with perihilar obstruction. This study was designed to compare the microbiological characteristics of patients whose biliary trees were either exposed or not exposed to duodenal fluid, depending on the drainage method used.
The charts of 71 patients with perihilar obstruction (any etiology causing an obstruction parallel to that of a proximal cholangiocarcinoma according to the Bismuth-Corlette classification) were evaluated retrospectively. The contacted group comprised 20 patients who underwent either endoscopic stenting or percutaneous transhepatic biliary drainage (PTBD) with duodenal extension, while the non-contacted group consisted of 51 patients with either external PTBD or surgery upfront.
Positive bile culture results were identified in 19/20 (95%) vs. 17/51 (33%) patients ( = 0.00001) and multimicrobial growth in 13/19 (68%) vs. 4/17 (24%) ( = 0.007) patients in the contacted group and non-contacted group, respectively. Colonization of bile with multidrug-resistant (MDR) and extensively drug-resistant (XDR) bacteria was worse in the contacted group: 13/19 (68%) vs. 5/17 (29%) ( = 0.02). Significant differences were also found in the frequencies of carbapenem-resistant Enterobacterales (CRE) colonization: in the contacted group, positive CRE culture ( = 0.033) and PCR ( = 0.01) were more frequent.
The mode of the biliary drainage-duodenal vs. directly external-significantly modifies the microbiological characteristics of the patients with perihilar obstruction. Catheterization methods that entail continuous exposure of the biliary tree to duodenal fluid are associated with higher frequencies of bactibilia, presence of MDR and XDR bacteria in the bile, and intestinal colonization with CRE.
胆管引流常用于肝门部梗阻患者。本研究旨在根据所采用的引流方法，比较胆管树暴露于十二指肠液和未暴露于十二指肠液的患者的微生物学特征。
回顾性评估71例肝门部梗阻患者（根据Bismuth-Corlette分类，任何病因导致的梗阻与近端胆管癌平行）的病历。接触组包括20例行内镜支架置入术或经皮经肝胆道引流（PTBD）并带有十二指肠延伸的患者，而非接触组由51例行外部PTBD或先行手术的患者组成。
接触组19/20（95%）患者胆汁培养结果为阳性，非接触组为17/51（33%）患者（P = 0.00001）；接触组13/19（68%）患者存在多种微生物生长，非接触组为4/17（24%）患者（P = 0.007）。接触组胆汁中多重耐药（MDR）和广泛耐药（XDR）细菌的定植情况更差：13/19（68%） vs. 5/17（29%）（P = 0.02）。在耐碳青霉烯类肠杆菌科细菌（CRE）定植频率方面也发现了显著差异：在接触组中，CRE培养阳性（P = 0.033）和PCR阳性（P = 0.01）更为常见。
胆管引流方式——十二指肠引流与直接外部引流——显著改变了肝门部梗阻患者的微生物学特征。使胆管树持续暴露于十二指肠液的置管方法与胆汁菌血症的高发生率、胆汁中MDR和XDR细菌的存在以及CRE的肠道定植相关。
