The role of preoperative antibiotic prophylaxis in the relationship between intestinal colonization and post-ERCP biliary tract infection: a prospective cohort study
Abstract
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. 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. 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. Our analysis did not find significant evidence that intestinal colonization independently increases PEBTI…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 2,110 participants or records.
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