Antimicrobial resistance and infection control · 2026
The role of preoperative antibiotic prophylaxis in the relationship between intestinal colonization and post-ERCP biliary tract infection: a prospective cohort study.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Li Peng, Chen Yin, Li Zhenjuan, Liu Junping, Zhang Jiangfeng, Wang Yuzhu, Guo Leilei, Li Yuanyuan, Hu Bin, Zhu Shichao, Bao Junzhe, Sun Mingjie
Аннотация
BACKGROUND: Post-ERCP biliary tract infection (PEBTI) is a critical complication influenced by multiple factors, yet the role of preoperative antibiotic prophylaxis remains unclear. This study investigated the relationship between intestinal colonization and PEBTI, and whether antibiotic prophylaxis mediates this association.
METHODS: A multi-center, prospective cohort of 2110 patients undergoing ERCP for biliary obstruction was analyzed. Preoperative rectal swabs screened for common intestinal colonizers. Directed acyclic graphs (DAGs), Cox regression models, inverse probability of treatment weighting (IPTW), and mediation analysis were employed to assess confounders, effect estimates, and mechanistic pathways.
RESULTS: PEBTI occurred in 100 (4.7%) enrolled patients, and intestinal colonization was detected in 343 (16.2%), predominantly ESBL-producing Escherichia coli (73.2%). Initial unadjusted analysis showed a significant association between intestinal colonization and PEBTI (HR = 2.18, 95% CI 1.41-3.36). However, after adjusting for DAG-suggested confounders, the association attenuated to non-significance (adjusted HR = 1.53, 95% CI 0.89-2.66). Mediation analysis revealed no significant indirect effect via antibiotic prophylaxis (HR = 0.93, P = 0.132), accounting for 21% of the observed attenuation. Sensitivity analyses by trimmed-IPTW and stratified center confirmed robustness of findings.
CONCLUSIONS: Our analysis did not find significant evidence that intestinal colonization independently increases PEBTI risk. The observed associations appear to be largely confounded by patient vulnerability factors, with no significant evidence of mediation by antibiotic prophylaxis. These findings suggest prioritizing host-directed prevention strategies over pathogen-directed interventions in clinical practice.
METHODS: A multi-center, prospective cohort of 2110 patients undergoing ERCP for biliary obstruction was analyzed. Preoperative rectal swabs screened for common intestinal colonizers. Directed acyclic graphs (DAGs), Cox regression models, inverse probability of treatment weighting (IPTW), and mediation analysis were employed to assess confounders, effect estimates, and mechanistic pathways.
RESULTS: PEBTI occurred in 100 (4.7%) enrolled patients, and intestinal colonization was detected in 343 (16.2%), predominantly ESBL-producing Escherichia coli (73.2%). Initial unadjusted analysis showed a significant association between intestinal colonization and PEBTI (HR = 2.18, 95% CI 1.41-3.36). However, after adjusting for DAG-suggested confounders, the association attenuated to non-significance (adjusted HR = 1.53, 95% CI 0.89-2.66). Mediation analysis revealed no significant indirect effect via antibiotic prophylaxis (HR = 0.93, P = 0.132), accounting for 21% of the observed attenuation. Sensitivity analyses by trimmed-IPTW and stratified center confirmed robustness of findings.
CONCLUSIONS: Our analysis did not find significant evidence that intestinal colonization independently increases PEBTI risk. The observed associations appear to be largely confounded by patient vulnerability factors, with no significant evidence of mediation by antibiotic prophylaxis. These findings suggest prioritizing host-directed prevention strategies over pathogen-directed interventions in clinical practice.