Evaluation of Blood and Biliary Drainage Cultures and Mortality after Percutaneous Transhepatic Biliary Drainage Procedure

Introduction: Bacteremia and bile duct infection following percutaneous transhepatic biliary drainage (PTBD) are severe complications. Thus, the aim of this study was to investigate the risk factors of mortality and to evaluate the differences between blood and biliary drainage culture positive patients after PTBD. Materials and Methods: This is a retrospective study of 90 patients without any signs of infection prior to the PTBD procedures. Of these patients, we further divided them into three groups based on culture results: 1) first group was only bacteremic, 2) second group was only bile drainage culture-positive, and 3) third group was both bacteremic and bile drainage culture-positive. We compared clinical and laboratory parameters between these three groups and also evaluated the culture results in a high-resistance setting. Results:  There were 90 patients who developed bacteremia, bile duct infections or both. In the laboratory findings, bacteremic patients showed significantly higher serum level of alanine aminotransferase (ALT) (p=0.001). Elevated neutrophil counts, lipase levels and carbapenem-resistant isolates were found to be the independent risk factors for 30-day mortality after PTBD. (p=0.01, p=0.01, and p=0.04, respectively). Gram-negative organisms were present in 71.2% of the cases; Escherichia coli was the most common species (28.1%) followed by Enterococcus faecium (18.1%), Klebsiella pneumoniae (15.8%) and Pseudomonas aeruginosa (9.9%). 51 (41.8%) of the cultured gram-negative bacteria were extended spectrum beta-lactamases positive and carbapenem resistance was found in 27 (15.8%) isolates. Conclusion: Elevated ALT level was only difference between three groups. Therefore, bacteremic and bile culture positive patients should be treated with the same care. Elevated neutrophil counts, lipase levels and carbapenem-resistant isolates were the independent risk factors for mortality. Finally, the choice of antibiotic prophylaxis should be reviewed according to the antimicrobial resistance profiles.