Antibiotic prophylaxis for endoscopic retrograde chlangiopancreatography increases the detection rate of drug-resistant bacteria in bile

• Published in: Journal of hepato-biliary-pancreatic sciences Vol. 21; no. 9; pp. 712 - 718
• Main Authors: Minami, Tomoyuki, Sasaki, Tamito, Serikawa, Masahiro, Ishigaki, Takashi, Murakami, Yoshiaki, Chayama, Kazuaki
• Format: Journal Article
• Language: English
• Published: Japan Blackwell Publishing Ltd 01.09.2014; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - pharmacology; Antibiotic Prophylaxis; Antibiotics; Bacteria; Bile - microbiology; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis - diagnostic imaging; Cholangitis - microbiology; Drug resistance; Drug Resistance, Bacterial; Drug-resistant bacteria; Endoscopic retrograde cholangiopancreatography; Endoscopy; Female; Humans; Male; Middle Aged; Multivariate analysis; Risk Factors; Antibiotic prophylaxis; Endoscopic retrograde cholangiopancreatography; Drug-resistant bacteria
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1002/jhbp.129

Background No consensus has yet been reached regarding the utility of antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP). However, there has been little discussion of potential adverse effects of antibiotic use. This study investigated the impact of antibiotic prophylaxis on overall levels of bacterial infiltration of the biliary tract and the prevalence of drug‐resistance among that population. Methods Ninety‐three patients, from whom intraoperative bile samples were collected after performing ERCP, were assigned to either an antibiotic‐prophylaxis group (AP, n = 58) or a no‐antibiotic‐prophylaxis group (NAP, n = 35). Detection rates of biliary bacteria and antibiotic resistance were determined for each group. Multivariate analysis was also performed to identify risk factors for the development of drug‐resistant biliary bacteria. Results The bile contamination rate was 37.1% for the NAP group and 55.2% for the AP group (P = 0.09). Drug‐resistant bacteria were found in 5.7% of the NAP group and 29.3% of the AP group (P = 0.006). Biliary drainage and antibiotic prophylaxis for ERCP were identified as risk factors for the presence of drug‐resistant bacteria. Conclusion Administration of antibiotic prophylaxis prior to ERCP can be a risk factor for the selection of drug‐resistant bacteria in the biliary tract.