Analysis of bile colonization and intestinal flora may improve management in liver transplant recipients undergoing ERCP.
BACKGROUND
Immunosuppression, denervation of biliary tract, and presence of biliary strictures favor colonization of bile with microorganisms after liver transplantation. Little is known about spectrum and antibiotic susceptibility of this colonization.


METHODS
Bile and feces were collected prospectively from 38 patients who underwent endoscopic retrograde cholangiopancreaticography after liver transplantation. Samples were analyzed for colonization and antibiotic susceptibility.


RESULTS
From the 38 tested bile samples, 86.6% tested positive. Of those, 26 (78.8%) were polymicrobial. Of isolated bile samples, 52 (64.2%) were gram-positive, 22.2% were gram-negative, and 13.6% revealed Candida albicans. Most detectable gram-positive bacteria were Enterococcus faecium. Most detectable gram-negative bacteria were E. coli and Klebsiella pneumonia. Our analyses revealed high resistance rates of the isolates. Only 55.6% of isolates were sensitive to ciprofloxacin, 54% were sensitive to piperacillin/tazobactam, and 60.3% were sensitive to imipenem. High susceptibility rates were found for linezolid and vancomycin (72.9% and 72.6%, respectively). We found a high correlation between microorganisms found in bile and those isolated from stool.


CONCLUSIONS
Bile of liver transplant recipients is frequently colonized with microorganisms. The starting point of this colonization is usually the intestine. Systematic analysis of bile colonization during endoscopic interventions on biliary tracts of liver transplant recipients might help to select effective prophylactic antibiotic regimes as well as to facilitate the choice of suitable antimicrobial therapy in case of septic complications.
Department of Transplant Medicine, University Hospital Münster, Münster, Germany.
Iyad
I
Kabar
Department of Transplant Medicine, University Hospital Münster, Münster, Germany.
Anna
A
Hüsing
Department of Transplant Medicine, University Hospital Münster, Münster, Germany.
Vito R
VR
Cicinnati
Department of Transplant Medicine, University Hospital Münster, Münster, Germany.
Laura
L
Heitschmidt
Department of Transplant Medicine, University Hospital Münster, Münster, Germany.
Susanne
S
Beckebaum
Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany.
Gerold
G
Thölking
Department of Transplant Medicine, University Hospital Münster, Münster, Germany.
Hartmut H
HH
Schmidt
Institute of Hygiene, University Hospital Münster, Münster, Germany.
Helge
H
Karch
Institute of Hygiene, University Hospital Münster, Münster, Germany.
Frank
F
Kipp
D000328:Adult; D000368:Aged; D001646:Bile / Q000382:microbiology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology; D005260:Female; D000069196:Gastrointestinal Microbiome / Q000502:physiology*; D006801:Humans; D007709:Klebsiella / Q000302:isolation & purification; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies