Antibiotic Prophylaxis Optimization Using Fecal Surveillance Culture in Operated Biliary Atresia Patients: A Retrospective Study on Cholangitis Prevention

A BSTRACT Objectives: Antibiotics are central to preventing and treating cholangitis following Kasai portoenterostomy (KPE).There is an increasing evidence of resistance to commonly used antibiotics. Study explores an inexpensive and noninvasive method of monitoring and adapting antibiotic therapy post KPE using fecal surveillance cultures (FSCs).Primary aim was to assess load of antibiotic resistance among organisms isolated on FSC and the effect of choosing antibiotic based on this resistance pattern. One secondary aim was to assess the relationship between steroid initiation following KPE and cholangitis. Methods: It is a retrospective, observational study including 55 post-KPE patients. FSC were used to guide antibiotic prophylaxis and to tailor treatment during cholangitis episodes in select patients unresponsive to standard therapy. Results: Post-KPE FSC was performed in 45.45% (25/55) patients, isolating Escherichia coli and Klebsiella pneumoniae , with notable resistance to cephalosporins, fluoroquinolones, and carbapenems; tigecycline showed the least resistance. During cholangitis episodes, FSC was done in 65.52% (19/29) cases, isolating E. coli , K. pneumoniae , Enterobacter cloacae , and Pseudomonas aeruginosa . Cephalosporin and fluoroquinolone resistance was highest followed by carbapenem and aminoglycoside with lowest being tigecycline resistance. Resistance was significantly higher in Klebsiella compared to E. coli ( P < 0.05). Steroid initiation was significantly earlier in patients who developed cholangitis (15.27 ± 7.69 days post-KPE) compared to those who did not (21.47 ± 9.43 days; P = 0.019). Conclusion: Antibiotic prophylaxis post-KPE should be guided as per the FSC-sensitivity pattern as the rates of resistance to commonly used antibiotics is high. Caution is needed in initiating steroids very early after surgery.