Trends in Antimicrobial Resistance Among Postbiliary and Gastrointestinal Surgical Site Pathogens: A Tertiary Hospital Surveillance Report
DOI:
https://doi.org/10.5281/zenodo.22664596Keywords:
antimicrobial resistance, biliary tract infection, surgical site infection, ESBL, antimicrobial stewardshipAbstract
Background: Gallstone disease and its complications remain among the most common indications for abdominal surgery and
endoscopic intervention worldwide, and the biliary tract, once infected, becomes a distinct reservoir for the organisms that go on to
cause postbiliary and gastrointestinal surgical site infection. Bile culture surveillance over the past decade has documented a
marked rise in extended-spectrum beta-lactamase (ESBL) production among biliary Enterobacterales and an emerging, if still less
frequent, presence of carbapenem-resistant organisms.
Objective: This review synthesizes the published literature on antimicrobial resistance trends among pathogens causing postbiliary
and gastrointestinal surgical site infection, with particular attention to biliary tract microbiology, resistance mechanisms, and the
stewardship implications specific to cholecystectomy, biliary surgery, and endoscopic retrograde cholangiopancreatography
(ERCP).
Scope: Drawing on bile culture surveillance series, cohort studies, outbreak reports, and major society guidelines from Asia, Europe,
and the Americas, we describe the dominant biliary pathogens (Escherichia coli, Klebsiella pneumoniae, Enterococcus species), the
substantial center-to-center variability in ESBL and carbapenem resistance prevalence, the recurring risk factors for
resistant-organism infection (prior antibiotic exposure, recurrent instrumentation, healthcare-associated acquisition), and the
device-mediated transmission pathway illustrated by duodenoscope-associated carbapenem-resistant Klebsiella outbreaks. We
also review resistance mechanisms and current stewardship and prevention strategies, including bile-specific antibiograms,
risk-stratified empirical therapy, selective surgical prophylaxis, and endoscope reprocessing surveillance.
Conclusions: Resistance among postbiliary and gastrointestinal surgical pathogens has shifted from an occasional finding to a
routine clinical consideration, but its magnitude varies too widely across centers to support any single universal empirical regimen.
Locally calibrated, risk-stratified management, robust biliary source control, and dedicated attention to endoscopic equipment as
a transmission route emerge as the most consistently supported strategies across the reviewed literature.
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