Multidrug resistance of isolated microorganisms in occluded bile duct stents.
OBJECTIVE
Biliary stents have been used for benign or malignant biliary strictures, preoperative biliary drainage, resolution of biliary or pancreatic leaks, and dissolution treatment of non-extractable bile duct stones since 1979, and should be replaced at 3-6 month intervals. The aim of this cross-sectional pioneer study was to identify the microorganisms in occluded bile duct stents and to determine incidence and diagnosis of multidrug resistance of the isolated microorganisms in stents and in blood cultures.


METHODS
Fifty-one patients (14F, 37M, mean age: 58.2+/-11.6 yr) with cholangitis due to occluded stents were studied consecutively and prospectively after stent replacement was done. Independent variables were age, gender, underlying disease, duration of disease, size, length and period of stents, and blood biochemistry. Dependent variables were microorganisms isolated from the stent content and blood of the patients and the results of antibiogram tests.


RESULTS
Primary disease was malignant in 25 (49.0%), stent size was 7F in 30 (58.8%), and stent length was 11 cm in 11 (21.6%) and 15 cm in 12 (23.5%) of the patients. The mean period after the 1st stent application was 207.0+/-111.3 days and the last stent duration was 111.0+/-64.0 days. Isolated microorganisms from stents and blood, respectively, were Escherichia coli (E. coli) (43.4%, 20.8%), Klebsiella spp. (17.1%, 17.0%), Pseudomonas aeruginosa (P. aeruginosa) (13.2%, 18.9%) and Enterococcus spp. (10.5%, 17.0%). Isolated microorganisms showed multidrug resistance at high percentages (81.6% for stent, 81.1% for blood). ALT, AST, ALP, and direct bilirubin levels showed statistically significant differences between the benign and malignant groups.


CONCLUSIONS
All bile duct stents are contaminated by microorganisms, of which a high majority has multidrug resistance, and they frequently cause biliary sepsis. Biliary sepsis can be prevented by changing the stents periodically and by using proper antibiotic prophylaxis.
Demirbağ
Ali E
AE
Department of Gastrointestinal Surgery, Türkiye Yüksek Ihtisas Post-Graduate Teaching and Research Hospital, Ankara. alidemirbag@superonline.com
Karademir
Asli
A
Parlak
Erkan
E
Sen
Süha
S
Karahan
Mehmet
M
Kayaalp
Cüneyt
C
Sahin
Burhan
B
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D002761:Cholangitis / Q000382:microbiology / Q000601:surgery; D002779:Cholestasis / Q000601:surgery*; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents / Q000382:microbiology*
D000900:Anti-Bacterial Agents