Epidemiology and Resistance Patterns of Bacterial and Fungal Colonization of Biliary Plastic Stents: A Prospective Cohort Study

• Published in: PloS one 2016-05, Vol.11 (5), p.e0155479-e0155479
• Main Authors: Lübbert, Christoph, Wendt, Karolin, Feisthammel, Jürgen, Moter, Annette, Lippmann, Norman, Busch, Thilo, Mössner, Joachim, Hoffmeister, Albrecht, Rodloff, Arne C
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anaerobes; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotic resistance; Antibiotics; Antiinfectives and antibacterials; Antimicrobial agents; Antimicrobial resistance; Bacteria; Bacteria - drug effects; Bacteria - growth & development; Bacteria - isolation & purification; Bile; Biliary tract; Biliary Tract - microbiology; Biliary Tract - pathology; Biofilms; Biofilms - drug effects; Biofilms - growth & development; Biology and Life Sciences; Body Fluids; Candida; Child; Cholangitis; Ciprofloxacin; Cohort analysis; Colonization; Colony Count, Microbial; Complications and side effects; Consortia; Deoxyribonucleic acid; DNA; Drug Resistance, Microbial - drug effects; Empirical analysis; Endoscopes; Endoscopy; Enterobacteriaceae; Epidemiology; Ethics; Etiology; Female; Fluorescence; Fluorescence in situ hybridization; Fungi; Fungi - drug effects; Fungi - growth & development; Fungi - isolation & purification; Gallbladder diseases; Gastroenterology; Hospitals; Humans; Implants; Infections; Infectious diseases; Ionization; Klebsiella pneumoniae; Liver Transplantation; Maintenance and repair; Male; Males; Mass spectrometry; Mass spectroscopy; Medicine and Health Sciences; Microbial Sensitivity Tests; Microbiological analysis; Microbiology; Microorganisms; Middle Aged; Mortality; Occlusion; Pathogens; Patients; Physiological aspects; Plastics; Polyethylene; Polyethylenes; Polyurethane; Polyurethane resins; Prospective Studies; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - epidemiology; Prosthesis-Related Infections - microbiology; Research and Analysis Methods; Rheumatology; Sonication; Species; Stenosis; Stents; Stents - adverse effects; Stents - microbiology; Stricture; Studies; Surgical implants; Systematic review; Time Factors; Transplants & implants; Typing; Vancomycin; Young Adult; β Lactamase
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0155479

Plastic stents used for the treatment of biliary obstruction will become occluded over time due to microbial colonization and formation of biofilms. Treatment of stent-associated cholangitis is often not effective because of inappropriate use of antimicrobial agents or antimicrobial resistance. We aimed to assess the current bacterial and fungal etiology of stent-associated biofilms, with particular emphasis on antimicrobial resistance. Patients with biliary strictures requiring endoscopic stent placement were prospectively enrolled. After the retrieval of stents, biofilms were disrupted by sonication, microorganisms were cultured, and isolates were identified by matrix-associated laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry and/or biochemical typing. Finally, minimum inhibitory concentrations (MICs) were determined for various antimicrobial agents. Selected stents were further analyzed by fluorescence in situ hybridization (FISH). Among 120 patients (62.5% males, median age 64 years) with biliary strictures (35% malignant, 65% benign), 113 double pigtail polyurethane and 100 straight polyethylene stents were analyzed after a median indwelling time of 63 days (range, 1-1274 days). The stent occlusion rate was 11.5% and 13%, respectively, being associated with a significantly increased risk of cholangitis (38.5% vs. 9.1%, P