{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T16:42:49Z","timestamp":1786725769643,"version":"build-2736575974"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>\n                    A\n                    <jats:sc>BSTRACT<\/jats:sc>\n                  <\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Post-KPE FSC was performed in 45.45% (25\/55) patients, isolating\n                      <jats:italic toggle=\"yes\">Escherichia coli<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                      , 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\n                      <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">Enterobacter cloacae<\/jats:italic>\n                      , and\n                      <jats:italic toggle=\"yes\">Pseudomonas aeruginosa<\/jats:italic>\n                      . Cephalosporin and fluoroquinolone resistance was highest followed by carbapenem and aminoglycoside with lowest being tigecycline resistance. Resistance was significantly higher in\n                      <jats:italic toggle=\"yes\">Klebsiella<\/jats:italic>\n                      compared to\n                      <jats:italic toggle=\"yes\">E. coli<\/jats:italic>\n                      (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). Steroid initiation was significantly earlier in patients who developed cholangitis (15.27 \u00b1 7.69 days post-KPE) compared to those who did not (21.47 \u00b1 9.43 days;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.019).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jiaps.jiaps_225_25","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T20:00:36Z","timestamp":1778011236000},"page":"388-395","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Antibiotic Prophylaxis Optimization Using Fecal Surveillance Culture in Operated Biliary Atresia Patients: A Retrospective Study on Cholangitis Prevention"],"prefix":"10.4103","volume":"31","author":[{"given":"Ruchi","family":"Mishra","sequence":"first","affiliation":[{"name":"Department of Pediatric Gastroenterology and Hepatology, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ira","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology and 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