Changing trend in bile microbiology and antibiotic susceptibilities: over 12 years of experience

ObjectivePrimary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease often leading to end-stage liver disease. Its pathogenesis remains largely unknown, although frequent concomitant IBD hints towards common factors underlying gut and bile duct inflammation. Considering the mounting evidence on the involvement of the intestinal microbiota in initiating and determining IBD phenotype, we investigated intestinal microbiota composition in patients with PSC.DesignStool samples were collected from 147 individuals (52 patients with PSC, 52 age, gender and body mass index-matched healthy volunteers, 13 UC and 30 patients with Crohn's disease). An independent validation cohort of 14 PSC and 14 matched controls was recruited. 16S rDNA sequencing of faecal DNA was performed (Illumina MiSeq).ResultsThe microbiota of patients with PSC was characterised by decreased microbiota diversity, and a significant overrepresentation of Enterococcus (p=3.76e-05), Fusobacterium (p=3.76e-05) and Lactobacillus (p=0.0002) genera. This dysbiosis was present in patients with PSC with and without concomitant IBD and was distinct from IBD, and independent of treatment with ursodeoxycholic acid. A decision tree based on abundances of these three genera allowed reliable classification in the validation cohort. In particular, one operational taxonomic unit belonging to the Enterococcus genus was associated with increased levels of serum alkaline phosphatase (p=0.048), a marker of disease severity.ConclusionsWe here present the first report of PSC-associated faecal dysbiosis, independent from IBD signatures, suggesting the intestinal microbiota could be a contributing factor in PSC pathogenesis. Further studies are needed to confirm these findings and assess causality.

show abstract

“…Enterococcus is the most frequently identified genus in bile culture studies, specifically E. faecium . 35 …”

Section: Discussionmentioning

confidence: 99%

Primary sclerosing cholangitis is characterised by intestinal dysbiosis independent from IBD

Sabino

Vieira-Silva

Machiels

et al. 2016

Gut

322

278

View full text Add to dashboard Cite

show abstract

“…and C. perfringens belonged to the most predominant anaerobes. Several studies also reported Enterobacteriaceae as the most predominant biliary pathogens . At the genus level, studies have yielded differing results as to whether E. coli or Enterococcus spp.…”

Section: Discussionmentioning

confidence: 99%

“…Nonfermenting pathogens such as P. aeruginosa and S. maltophilia were difficult to categorise because of a remarkable variety of isolation rates in the literature. The isolation rates of P. aeruginosa range from 4% to more than 17% . These inconsistent isolation rates might be related to the fact that nonfermenters such as P. aeruginosa are often isolated as a result of contamination during the endoscopic procedure rather than real colonisation of the biliary tract .…”

Section: Discussionmentioning

confidence: 99%

“… ‘biliary flora’ – most frequently isolated pathogens from bile fluid: The group of Enterobacteriaceae, Enterococcus spp ., Bacteroides spp., and Clostridium perfringens ; ‘oropharyngeal flora’ – pathogens frequently isolated from the upper respiratory tract: Streptococcus viridans group, coagulase‐negative Staphylococcus spp., Staphylococcus aureus , beta‐haemolytic Streptococcus spp., Streptococcus pneumoniae , Lactobacillus spp., Leuconostoc spp., Corynebacterium spp., Haemophilus influenzae , Peptostreptococcus anaerobius , Veillonella spp. and Prevotella spp. ‘environmental flora’ – the main reservoirs of these pathogens are soil, water or hospital environments: Pseudomonas aeruginosa , Stenotrophomonas maltophilia , Achromobacter spp., Acinetobacter spp., Methylobacterium mesophilicum , other nonfermenting spp.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

The use of proton pump inhibitors and the spectrum and number of biliary pathogens in patients with acute cholangitis

Schneider

Weidner

Hapfelmeier

et al. 2014

Aliment Pharmacol Ther

View full text Add to dashboard Cite

Summary Background Knowledge of the bacterial spectrum for acute cholangitis is essential for adequate empiric antibiotic treatment. Aim To analyse the relation of proton pump inhibitors (PPI) with biliary pathogens in patients with acute cholangitis. Methods This retrospective study identified 278 patients with 318 acute cholangitis episodes using an endoscopic database. The relationship between PPI and microbiological outcomes was assessed by logistic and poisson regression analysis for binary and count data. Results In total, 882 pathogens were isolated, of which, 120 cholangitis episodes occurred with PPI; 198 cholangitis episodes without PPI. Multivariate poisson regression analysis showed that PPI use resulted in a 23% increase in the number of biliary pathogens [3.14 vs. 2.55 (Δ = 0.59), P < 0.01], whereas stent therapy, previous interventional procedures (endoscopic retrograde cholangiography/percutaneous transhepatic cholangiography), genesis, age and sex showed no significant association with the number of biliary pathogens. Significantly, more cholangitis episodes with more than one pathogen isolated occurred during PPI treatment [103/120 (86%) vs. 151/198 (76%), P = 0.04]. Analysis of intrinsic anti‐microbial resistance patterns was performed: Anti‐microbial combination therapies were significantly more required to cover all isolated pathogens in cholangitis episodes with PPI than in cholangitis episodes without PPI (44/120 vs. 46/198, P = 0.01). Additionally, PPI use was associated with a significantly higher incidence of oropharyngeal flora in the biliary tract (53/120 vs. 61/198, P = 0.02). Conclusions Proton pump inhibitors seem to influence biliary pathogens by increasing the number and broadening the spectrum of biliary pathogens. However, the findings of this hypothesis‐generating study need to be tested by confirmatory studies.

show abstract

“…Among them, isolation of Aeromonas hydrophila (A hydrophila) is relatively low in incidence. 3,4 Aeromonas hydrophila are Gram-negative, facultatively anaerobic bacillus bacteria, and are widely prevalent in aquatic environments. Pathogenesis of A hydrophila in humans is known as gastroenteritis, 5 and is associated with food poisoning.…”

Section: Introductionmentioning

confidence: 99%

Mortality analysis of Aeromonas hydrophila infection in hepato‐biliary pancreatic surgery: Multicenter retrospective observational study

Ueno

Iida

Kaibori

et al. 2020

J Hepato Biliary Pancreat

View full text Add to dashboard Cite

Background/Purpose: Aeromonas hydrophila can cause lethal infectious complications after surgery. There have been no large cohort studies of this specific to the hepato-biliary-pancreatic (HBP) field. We investigate the postoperative influence of A hydrophila infection after HBP surgery. Methods: We retrospectively reviewed patients who underwent HBP surgery between 2008 and 2017 at eight university hospitals. Patients with A hydrophila isolation during perioperative management were extracted, and their postoperative courses were investigated. Results: Bacterial culture examination of 10 074 patients was performed as perioperative management. Among them, 76 patients (0.75%) had A hydrophila isolation, most of whom underwent pancreatoduodenectomy (n = 38) or hepatectomy with biliary reconstruction (n = 14). There were seven mortalities after these two procedures (13.5%), five within 3 days after the onset of infection. Bile (n = 48) and abdominal drainage fluid (n = 29) were major sites of A hydrophila isolation. Typical prophylactic antibiotics, cefazolin or flomoxef, were mostly resistant. There was no mortality among patients that received sensitive antibiotics prophylactically. Conclusions: Isolation of A hydrophila was low in our cases of HBP surgery, but the condition of some patients deteriorated rapidly by this infection. Although there could be several bacterial infections during management of HBP surgery, A hydrophila should not be overlooked. Preparation of appropriate prophylactic antibiotics may prevent or reduce mortality.

show abstract

Changing trend in bile microbiology and antibiotic susceptibilities: over 12 years of experience

Cited by 37 publications

References 36 publications

Primary sclerosing cholangitis is characterised by intestinal dysbiosis independent from IBD

Primary sclerosing cholangitis is characterised by intestinal dysbiosis independent from IBD

The use of proton pump inhibitors and the spectrum and number of biliary pathogens in patients with acute cholangitis

Mortality analysis of Aeromonas hydrophila infection in hepato‐biliary pancreatic surgery: Multicenter retrospective observational study

Contact Info

Product

Resources

About