Summary of clinical evidence for biliary infection prevention strategies after percutaneous transhepatic biliary drainage: an evidence synthesis

To retrieve and extract the available evidence for the prevention of biliary tract infections associated with percutaneous transhepatic biliary drainage (PTBD) and provide evidence-based support for reducing their incidence. Using the PIPOST tool, we formulated an evidence-based question and conducted searches in relevant Chinese and international databases and websites for clinical decisions, guidelines, evidence summaries, systematic reviews, randomized controlled trials and expert consensus on the use of management strategies for preventing post-PTBD biliary infections. The search was limited to the literature published until July 31, 2025. We performed a quality assessment and evidence extraction on the eligible documents. This study included 14 articles, including 6 guidelines, 3 expert consensus statements, 3 systematic reviews, and 2 randomized controlled trials. A total of 18 best pieces of evidence recommendations were summarized across 3 aspects, including preoperative preparation protocols for PTBD, intraoperative risk mitigation strategies, and postoperative care pathways for biliary infection prophylaxis. This study systematically synthesized the evidence for preventing biliary tract infections following PTBD, thereby providing evidence-based support for the development of targeted clinical implementation strategies in practice.