Association between clinically relevant antibiotic-resistant biliary colonization and liver-specific complications following perihilar cholangiocarcinoma resection.

BACKGROUND

International guidelines recommend first-generation cephalosporins for preoperative antibiotic prophylaxis in patients undergoing resection for perihilar cholangiocarcinoma (pCCA). Knowledge on the resistance profile of biliary bacteria and its impact on liver-specific complications is limited. This study aimed to evaluate the biliary microbial spectrum, particularly focusing on the impact of resistant bacteria on liver-specific complications following pCCA resection.

METHODS

This is a retrospective, single-center, observational study. All patients with resected pCCA at the University Hospital Frankfurt from July 2005 to December 2022 were included. The microbial spectrum was analyzed using intraoperative bile swabs.

RESULTS

From 118 patients, 104 had an intraoperative bile swab taken. Microorganisms (bacteria, fungi) were detected in 89.4% of cases. 24% of the samples contained clinically relevant antibiotic-resistant bacteria, which were related with more severe postoperative bile leaks requiring relaparotomy (24% versus 8.8%, p = 0.055) and posthepatectomy liver failure (48% versus 25.3%, p = 0.031). 76.9% of the microbial isolates were resistant to in-house standard antibiotic prophylaxis with cefuroxime.

CONCLUSION

Biliary colonization with clinically relevant antibiotic-resistant bacteria is associated with liver-specific complications.

© 2026. The Author(s).