title: Antibiotic prophylaxis for endoscopic retrograde chlangiopancreatography increases the detection rate of drug-resistant bacteria in bile.
abstract: 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.
  
  
  CONCLUSIONS
  Administration of antibiotic prophylaxis prior to ERCP can be a risk factor for the selection of drug-resistant bacteria in the biliary tract.
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. char-aznable@hiroshima-u.ac.jp.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Minami
authors.forename: Tamito
authors.initials: T
authors.lastname: Sasaki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Serikawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishigaki
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Murakami
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D019072:Antibiotic Prophylaxis; D001646:Bile / Q000382:microbiology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000000981:diagnostic imaging* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic prophylaxis; Drug-resistant bacteria; Endoscopic retrograde cholangiopancreatography