{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T21:46:26Z","timestamp":1790199986984,"version":"4.1.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2017,1,1]],"date-time":"2017-01-01T00:00:00Z","timestamp":1483228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,1,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with obstructive jaundice due to periampullary tumours may undergo preoperative biliary drainage (PBD). The effect of PBD on the microbiome of the biliary system and on postoperative outcome remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A single-centre retrospective study of patients with obstructive jaundice due to periampullary cancer, treated between July 2007 and July 2015, was undertaken. Intraoperative bile samples were obtained for microbiological analysis after transection of the common bile duct. Postoperative complications were registered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 290 patients treated, intraoperative bile samples were present for 172 patients (59\u00b73 per cent) who had PBD and 118 (40\u00b77 per cent) who did not. Contamination of bile was increased significantly in patients who underwent stenting (97\u00b71 per cent versus 18\u00b76 per cent in those without stenting; P &amp;lt; 0\u00b7001). PBD resulted in a shift in the biliary microbiome from Escherichia coli in non-stented patients (45 per cent versus 19\u00b72 per cent in stented patients; P = 0\u00b7009) towards increased contamination with Enterococcus faecalis (9 versus 37\u00b77 per cent respectively; P = 0\u00b7008) and Enterobacter cloacae (0 versus 20\u00b74 per cent; P = 0\u00b7033). This shift was associated with a high incidence of bacterial resistance against ampicillin\u2013sulbactam (63\u00b76 per cent versus 18 per cent in patients with no PBD; P &amp;lt; 0\u00b7001), piperacillin\u2013tazobactam (30\u00b71 versus 0 per cent respectively; P = 0\u00b7003), ciprofloxacin (28\u00b75 versus 5 per cent; P = 0\u00b7047) and imipenem (26\u00b76 versus 0 per cent; P = 0\u00b7011). The rate of wound infection was higher in patients with a positive bile culture (21\u00b70 per cent versus 6 per cent in patients with sterile bile; P = 0\u00b7002). Regression analysis revealed the presence of Enterococcus faecium (odds ratio 2\u00b783, 95 per cent c.i. 1\u00b717 to 6\u00b784; P = 0\u00b7021) and Citrobacter species (odds ratio 5\u00b709, 1\u00b765 to 15\u00b771; P = 0\u00b7005) as independent risk factors for postoperative wound infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>There are fundamental differences in the biliary microbiome of patients with periampullary cancer who undergo PBD and those who do not. PBD induces a shift of the biliary microbiome towards a more aggressive and resistant spectrum, which requires a differentiated perioperative antibiotic treatment strategy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bjs.10450","type":"journal-article","created":{"date-parts":[[2017,1,25]],"date-time":"2017-01-25T06:47:28Z","timestamp":1485326848000},"page":"e182-e188","source":"Crossref","is-referenced-by-count":102,"title":["Effect of preoperative biliary drainage on bacterial flora in bile of patients with periampullary cancer"],"prefix":"10.1093","volume":"104","author":[{"given":"F","family":"Scheufele","sequence":"first","affiliation":[{"name":"Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Aichinger","sequence":"additional","affiliation":[{"name":"Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"J\u00e4ger","sequence":"additional","affiliation":[{"name":"Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I E","family":"Demir","sequence":"additional","affiliation":[{"name":"Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Schorn","sequence":"additional","affiliation":[{"name":"Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Sargut","sequence":"additional","affiliation":[{"name":"Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Erkan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany"},{"name":"Department of Surgery, Ko\u00e7 University Hospital, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Kleeff","sequence":"additional","affiliation":[{"name":"Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany"},{"name":"Department of Surgery, University of Liverpool, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Friess","sequence":"additional","affiliation":[{"name":"Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G O","family":"Ceyhan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2017,1,25]]},"reference":[{"key":"2021020617453380900_bjs10450-bib-0001","first-page":"v1","article-title":"British Society of Gastroenterology; Pancreatic Society of Great Britain and Ireland; Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland; Royal College of Pathologists; Special Interest Group for Gastro-Intestinal Radiology. 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