Pathogen detection in patients with perihilar cholangiocarcinoma: Implications for targeted perioperative antibiotic therapy

• Published in: Hepatobiliary & pancreatic diseases international Vol. 22; no. 5; pp. 512 - 518
• Main Authors: Dondorf, Felix, Graf, Maximilian, Deeb, Aladdin Ali, Rohland, Oliver, Felgendreff, Philipp, Ardelt, Michael, Settmacher, Utz, Rauchfuss, Falk
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 01-10-2023; Research Program"Else Kr?ner-Forschungskolleg AntiAge",Jena University Hospital,Jena 07747,Germany; Department of General,Visceral and Vascular Surgery,Jena University Hospital,Jena 07747,Germany%Department of General,Visceral and Vascular Surgery,Jena University Hospital,Jena 07747,Germany
• Subjects: Biliary drainage; Cholangitis; Klatskin tumor; Perihilar cholangiocarcinoma; Targeted antibiotic therapy; Perihilar cholangiocarcinoma; Biliary drainage; Klatskin tumor; Cholangitis; Targeted antibiotic therapy
• ISSN: 1499-3872
• DOI: 10.1016/j.hbpd.2022.01.005

Cholestasis should be relieved by biliary drainage prior to major liver resection. This condition is often associated with bacterial colonization of the otherwise sterile biliary system. Cholangitis reduces the regenerative capacity of the remaining liver. Therefore, targeted antibiotic therapy is a key feature in perioperative treatment in patients with perihilar cholangiocarcinoma (pCCC).
Between December 1999 and December 2017, 251 pCCC patients were treated in our center. In total, 115 patients underwent a microbiological analysis. In addition to the characterization of the specific microorganisms and antibiotic resistance, we analyzed subgroups according to preoperative intervention.
Enterococci (87/254, 34%) and Enterobacteria (65/254, 26%) were the most frequently detected genera. In 43% (50/115) of patients, Enterococcus faecalis was found in the bile duct sample. Enterococcus faecium (29/115) and Escherichia coli (29/115) were detected in 25% of patients. In patients with percutaneous transhepatic biliary drainage (3/8, 38%) or stents (24/79, 30%), Enterococcus faecium was diagnosed most frequently (P < 0.05). Enterococcus faecium and Klebsiella oxytoca were significantly more frequently noted in the time period after 2012 (P < 0.05). With regard to fungal colonization, the focus was on various Candida strains, but these strains generally lacked resistance.
pCCC patients exhibit specific bacterial colonization features depending on the type of preoperative biliary intervention. Specifically, targeted antibiosis should be applied in this patient cohort to minimize the risk of biliary complications after major liver resection. In our cohort, the combination of meropenem and vancomycin represents an effective perioperative medical approach.