Bacteriological profile of biliary tract infections in adults undergoing interventional biliopancreatic endoscopy

Interventional biliopancreatic endoscopy is an invasive procedure with a significant risk of infectious complications. This study aims to determine the most frequently isolated germs during biliopancreatic endoscopy and to study their sensitivity to antibiotics, to adapt antibiotic therapy, and to justify antibiotic prophylaxis.

A microbiological analysis of bile samples taken during endoscopic retrograde cholangiopancreatography was performed. The indication for the endoscopic examination was lithiasis of the main bile duct in 72 % of cases, malignant or benign biliary stenosis in 15.34 % and 6.83 % of cases, respectively, and prosthesis infection in 5.64 %. All samples were processed according to the recommendations of the medical microbiology reference system (REMIC).

108 bile samples and 16 biliary prostheses were analyzed. Bile culture was positive in 95.96 % (n = 119) of cases. The most frequently isolated germs were Escherichia coli (n = 47; 21 %), Enterococcus spp (n = 44; 19.7 %), Streptococcus spp (n = 37; 16.6 %), Klebsiella spp (n = 35; 15.7 %) and Pseudomonas spp (10.67 %). For the bacteria most frequently isolated in our work, we studied the susceptibility to the antibiotics proposed by the recommendations. Imipenem and amikacin demonstrated the best antimicrobial activity compared with amoxicillin/clavulanic acid, piperacillin/tazobactam, and ciprofloxacin, which were less active. Multidrug-resistant bacteria were noted in 15.25 % (n = 34) of cases.

This study concludes that the biliary system is a high-risk environment for infections. A bile sample for microbiological analysis can become a valuable diagnostic tool, as it allows more appropriate treatment and helps in the establishment of local antibiotic recommendations for the treatment of biliary tract infections.