Introduction Biliary sepsis and cholangitis are frequent complications of percutaneous transhepatic cholangiography and biliary drainage (PTCBD). Due to bacterial resistance, biliary infection is often difficult to eradicate. The aims of this audit were to evaluate the frequency of bile sample collection during PTCBD for culture and antibiotic sensitivity tests. Further, whether antibiotic management of biliary infections post-procedure are appropriate.
Methods A retrospective review of electronic patient records were conducted for 138 patients that underwent PTCBD for management of malignant biliary obstruction from 2012–2015 in the Interventional Radiology departments of the Oxford University Hospitals NHS Trust. Due to limitations of the electronic system, drug histories were only accessible from the 45 patients that underwent PTCBD in 2015.
Results Of the 138 patients, 36% had samples cultured during the procedure. Of the positive bile samples, 61% had antibiotic sensitivities reported. Organisms identified included mixed faecal flora (33%), anaerobes (12%), aerobic gram-positive cocci (23%), aerobic gram-negative (14%), Pseudomonas (7%) and Candida (7%). In 2015, 53% that underwent PTCBD received antibiotics for biliary infection, of these, 46% had bile cultures and of the positive samples, 33% were tested for antibiotic sensitivity. Antibiotics administered included: amoxicillin/clavulanic acid (30%), metronidazole (33%), gentamycin (14%), piperacillin/tazobactam (9%), ceftriaxone (9%), ciprofloxacin (5%).
Conclusion Thus, antibiotics to treat biliary infection following PTCBD are often prescribed without knowledge of the infective organism or its resistance and therefore may not be appropriate. Additionally, many of the treatments administered do not provide complete coverage of organisms identified in bile, notably Pseudomonas and Candida. Bile sample collection during PTCBD should become a standard procedure to delineate infective organisms and drug susceptibilities, hence driving a more targeted treatment in the event of biliary infection post-procedure, which may reduce mortality and costs associated with bacterial resistance.
Disclosure of Interest None Declared
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