PMID- 27171497 OWN - NLM STAT- MEDLINE DCOM- 20170710 LR - 20190219 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 11 IP - 5 DP - 2016 TI - Epidemiology and Resistance Patterns of Bacterial and Fungal Colonization of Biliary Plastic Stents: A Prospective Cohort Study. PG - e0155479 LID - 10.1371/journal.pone.0155479 [doi] LID - e0155479 AB - BACKGROUND: 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. METHODS: 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). RESULTS: 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<0.001). Ninety-five different bacterial and 13 fungal species were detected; polymicrobial colonization predominated (95.8% vs. 4.2%, P<0.001). Enterococci (79.3%), Enterobacteriaceae (73.7%), and Candida spp. (55.9%) were the leading pathogens. Candida species were more frequent in patients previously receiving prolonged antibiotic therapy (63% vs. 46.7%, P = 0.023). Vancomycin-resistant enterococci accounted for 13.7%, extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae with co-resistance to ciprofloxacin accounted for 13.9%, and azole-resistant Candida spp. accounted for 32.9% of the respective isolates. CONCLUSIONS: Enterococci and Candida species play an important role in the microbial colonization of biliary stents. Therefore, empirical antimicrobial treatment of stent-associated cholangitis should be guided toward enterococci, Enterobacteriaceae, streptococci, anaerobes, and Candida. To determine causative pathogens, an accurate microbiological analysis of the extracted stent(s) may be helpful. FAU - Lubbert, Christoph AU - Lubbert C AD - Interdisciplinary Endoscopy Unit, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany. AD - Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany. AD - Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, D-04103 Leipzig, Germany. FAU - Wendt, Karolin AU - Wendt K AD - Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany. FAU - Feisthammel, Jurgen AU - Feisthammel J AD - Interdisciplinary Endoscopy Unit, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany. FAU - Moter, Annette AU - Moter A AD - Biofilm Center, German Heart Institute (Deutsches Herzzentrum Berlin, DHZB), Hindenburgdamm 30, D-12203 Berlin, Germany. FAU - Lippmann, Norman AU - Lippmann N AD - Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, D-04103 Leipzig, Germany. AD - Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Liebigstr. 21, D-04103 Leipzig, Germany. FAU - Busch, Thilo AU - Busch T AD - Department of Anaesthesiology and Intensive Care Medicine, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany. FAU - Mossner, Joachim AU - Mossner J AD - Interdisciplinary Endoscopy Unit, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany. FAU - Hoffmeister, Albrecht AU - Hoffmeister A AD - Interdisciplinary Endoscopy Unit, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany. FAU - Rodloff, Arne C AU - Rodloff AC AD - Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, D-04103 Leipzig, Germany. AD - Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Liebigstr. 21, D-04103 Leipzig, Germany. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20160512 PL - United States TA - PLoS One JT - PloS one JID - 101285081 RN - 0 (Anti-Bacterial Agents) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Anti-Bacterial Agents/pharmacology/therapeutic use MH - Bacteria/drug effects/*growth & development/isolation & purification MH - Biliary Tract/*microbiology/*pathology MH - Biofilms/drug effects/growth & development MH - Body Fluids MH - Child MH - Colony Count, Microbial MH - Drug Resistance, Microbial/drug effects MH - Endoscopy MH - Female MH - Fungi/drug effects/*growth & development/isolation & purification MH - Humans MH - Liver Transplantation MH - Male MH - Microbial Sensitivity Tests MH - Middle Aged MH - Prospective Studies MH - Prosthesis-Related Infections/drug therapy/*epidemiology/*microbiology MH - Sonication MH - Stents/adverse effects/*microbiology MH - Time Factors MH - Young Adult PMC - PMC4865241 COIS- Competing Interests: The authors have declared that no competing interests exist. EDAT- 2016/05/14 06:00 MHDA- 2017/07/14 06:00 PMCR- 2016/05/12 CRDT- 2016/05/13 06:00 PHST- 2016/03/10 00:00 [received] PHST- 2016/04/29 00:00 [accepted] PHST- 2016/05/13 06:00 [entrez] PHST- 2016/05/14 06:00 [pubmed] PHST- 2017/07/14 06:00 [medline] PHST- 2016/05/12 00:00 [pmc-release] AID - PONE-D-16-09603 [pii] AID - 10.1371/journal.pone.0155479 [doi] PST - epublish SO - PLoS One. 2016 May 12;11(5):e0155479. doi: 10.1371/journal.pone.0155479. eCollection 2016.