Unfavorable microbiological impact of directly duodenal biliary drainage in patients with perihilar obstruction: a preliminary report
BackgroundBiliary 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.MethodsThe charts o...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2025.1538676/full |
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| author | Veronika Rozhkova Kamuran Tutuş Selda Kömeç Erdem Kınacı Özgür Bostancı İlgin Özden |
| author_facet | Veronika Rozhkova Kamuran Tutuş Selda Kömeç Erdem Kınacı Özgür Bostancı İlgin Özden |
| author_sort | Veronika Rozhkova |
| collection | DOAJ |
| description | BackgroundBiliary 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.MethodsThe 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.ResultsPositive bile culture results were identified in 19/20 (95%) vs. 17/51 (33%) patients (p = 0.00001) and multimicrobial growth in 13/19 (68%) vs. 4/17 (24%) (p = 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%) (p = 0.02). Significant differences were also found in the frequencies of carbapenem-resistant Enterobacterales (CRE) colonization: in the contacted group, positive CRE culture (p = 0.033) and PCR (p = 0.01) were more frequent.ConclusionsThe 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. |
| format | Article |
| id | doaj-art-d08c2ef5922b4766a51c9b03eb67f2ef |
| institution | Kabale University |
| issn | 2296-875X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Surgery |
| spelling | doaj-art-d08c2ef5922b4766a51c9b03eb67f2ef2025-08-20T03:50:26ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2025-07-011210.3389/fsurg.2025.15386761538676Unfavorable microbiological impact of directly duodenal biliary drainage in patients with perihilar obstruction: a preliminary reportVeronika Rozhkova0Kamuran Tutuş1Selda Kömeç2Erdem Kınacı3Özgür Bostancı4İlgin Özden5Department of General Surgery, Liver Transplantation & Hepatopancreatobiliary Surgery Unit, Başakşehir Çam & Sakura City Hospital, Istanbul, TürkiyeDepartment of General Surgery, Liver Transplantation & Hepatopancreatobiliary Surgery Unit, Başakşehir Çam & Sakura City Hospital, Istanbul, TürkiyeDepartment of Clinical Microbiology, Başakşehir Çam & Sakura City Hospital, Istanbul, TürkiyeDepartment of General Surgery, Liver Transplantation & Hepatopancreatobiliary Surgery Unit, Başakşehir Çam & Sakura City Hospital, Istanbul, TürkiyeDepartment of General Surgery, Liver Transplantation & Hepatopancreatobiliary Surgery Unit, Başakşehir Çam & Sakura City Hospital, Istanbul, TürkiyeDepartment of General Surgery, Liver Transplantation & Hepatopancreatobiliary Surgery Unit, Başakşehir Çam & Sakura City Hospital, Istanbul, TürkiyeBackgroundBiliary 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.MethodsThe 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.ResultsPositive bile culture results were identified in 19/20 (95%) vs. 17/51 (33%) patients (p = 0.00001) and multimicrobial growth in 13/19 (68%) vs. 4/17 (24%) (p = 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%) (p = 0.02). Significant differences were also found in the frequencies of carbapenem-resistant Enterobacterales (CRE) colonization: in the contacted group, positive CRE culture (p = 0.033) and PCR (p = 0.01) were more frequent.ConclusionsThe 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.https://www.frontiersin.org/articles/10.3389/fsurg.2025.1538676/fullbactibiliabiliary drainagecarbapenem-resistant Enterobacteralesextensively drug-resistantmultidrug-resistantperihilar |
| spellingShingle | Veronika Rozhkova Kamuran Tutuş Selda Kömeç Erdem Kınacı Özgür Bostancı İlgin Özden Unfavorable microbiological impact of directly duodenal biliary drainage in patients with perihilar obstruction: a preliminary report Frontiers in Surgery bactibilia biliary drainage carbapenem-resistant Enterobacterales extensively drug-resistant multidrug-resistant perihilar |
| title | Unfavorable microbiological impact of directly duodenal biliary drainage in patients with perihilar obstruction: a preliminary report |
| title_full | Unfavorable microbiological impact of directly duodenal biliary drainage in patients with perihilar obstruction: a preliminary report |
| title_fullStr | Unfavorable microbiological impact of directly duodenal biliary drainage in patients with perihilar obstruction: a preliminary report |
| title_full_unstemmed | Unfavorable microbiological impact of directly duodenal biliary drainage in patients with perihilar obstruction: a preliminary report |
| title_short | Unfavorable microbiological impact of directly duodenal biliary drainage in patients with perihilar obstruction: a preliminary report |
| title_sort | unfavorable microbiological impact of directly duodenal biliary drainage in patients with perihilar obstruction a preliminary report |
| topic | bactibilia biliary drainage carbapenem-resistant Enterobacterales extensively drug-resistant multidrug-resistant perihilar |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2025.1538676/full |
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