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Antibiotic Prophylaxis Optimization Using Fecal Surveillance Culture in Operated Biliary Atresia Patients: A
Ruchi Mishra1, Ira Shah1, Shivangi Tetarbe1
1Department of Pediatric Gastroenterology and Hepatology, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India.
Journal of Indian Association of Pediatric Surgeons
|June 18, 2026
Summary
Fecal surveillance cultures can guide antibiotic therapy after Kasai portoenterostomy (KPE) due to high antibiotic resistance. Early steroid use may increase cholangitis risk in post-KPE patients.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Microbiology
Background:
- Antibiotics are crucial for preventing and treating cholangitis after Kasai portoenterostomy (KPE).
- Growing antibiotic resistance necessitates adaptive therapeutic strategies.
- Fecal surveillance cultures (FSCs) offer a potential noninvasive monitoring method.
Purpose of the Study:
- To assess antibiotic resistance patterns in organisms isolated from FSCs post-KPE.
- To evaluate the impact of tailoring antibiotic therapy based on FSC resistance patterns.
- To investigate the association between early steroid initiation and cholangitis development post-KPE.
Main Methods:
- Retrospective observational study of 55 post-KPE patients.
- Fecal surveillance cultures (FSCs) used for prophylaxis and treatment guidance.
- Analysis of antibiotic resistance profiles and correlation with steroid initiation timing.
Main Results:
- Escherichia coli and Klebsiella pneumoniae were common isolates, showing high resistance to cephalosporins, fluoroquinolones, and carbapenems.
- Tigecycline exhibited the lowest resistance rates.
- Earlier steroid initiation was significantly associated with cholangitis development (P=0.019).
Conclusions:
- Antibiotic prophylaxis post-KPE should be informed by FSC sensitivity patterns due to high resistance rates.
- Tailoring antibiotic treatment based on FSC results is recommended.
- Caution is advised regarding early steroid initiation after KPE to mitigate cholangitis risk.
