Evidence map›Paper›PMID 41634842›Full record

ArticleAntimicrobial resistance and infection control2026

The role of preoperative antibiotic prophylaxis in the relationship between intestinal colonization and post-ERCP biliary tract infection: a prospective cohort study.

Peng Li, Yin Chen, Zhenjuan Li, Junping Liu, Jiangfeng Zhang, Yuzhu Wang, Leilei Guo, Yuanyuan Li, Bin Hu, Shichao Zhu and 2 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Antimicrobial resistance and infection control, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

12 authors.

Peng LiInfection Control Office, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, 7 Wei Wu Rd, Zhengzhou, 450003, China.
Yin ChenGastrointestinal Endoscopy Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
Zhenjuan LiGastroenterology Department, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
Junping LiuInfectious Disease Department, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
Jiangfeng ZhangMicrobiology Laboratory, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
Yuzhu WangHepatobiliary and Pancreatic Surgery Department, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
Leilei GuoInfection Prevention and Control Department, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China.
Yuanyuan LiInfection Prevention and Control Department, The First Affiliated Hospital of Nanyang Medical College, Nanyang, China.
Bin HuInfection Prevention and Control Department, Zhumadian Central Hospital, Zhumadian, China.
Shichao ZhuCentral Intensive Care Unit, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
Junzhe BaoCollege of Public Health, Zhengzhou University, Zhengzhou, China.
Mingjie SunInfection Control Office, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, 7 Wei Wu Rd, Zhengzhou, 450003, China. lpsxjlp@whu.edu.cn.

Funding

the Chinese Preventive Medicine Association HAIC-2024012900107the Health Commission of Henan Province SBGJ202103021
6 · The paper itself

Abstract

backgroundPost-ERCP biliary tract infection (PEBTI) is a critical complication influenced by multiple factors, yet the role of preoperative antibiotic prophylaxis remains unclear. This study investigated the relationship between intestinal colonization and PEBTI, and whether antibiotic prophylaxis mediates this association.

methodsA multi-center, prospective cohort of 2110 patients undergoing ERCP for biliary obstruction was analyzed. Preoperative rectal swabs screened for common intestinal colonizers. Directed acyclic graphs (DAGs), Cox regression models, inverse probability of treatment weighting (IPTW), and mediation analysis were employed to assess confounders, effect estimates, and mechanistic pathways.

resultsPEBTI occurred in 100 (4.7%) enrolled patients, and intestinal colonization was detected in 343 (16.2%), predominantly ESBL-producing Escherichia coli (73.2%). Initial unadjusted analysis showed a significant association between intestinal colonization and PEBTI (HR = 2.18, 95% CI 1.41-3.36). However, after adjusting for DAG-suggested confounders, the association attenuated to non-significance (adjusted HR = 1.53, 95% CI 0.89-2.66). Mediation analysis revealed no significant indirect effect via antibiotic prophylaxis (HR = 0.93, P = 0.132), accounting for 21% of the observed attenuation. Sensitivity analyses by trimmed-IPTW and stratified center confirmed robustness of findings.

conclusionsOur analysis did not find significant evidence that intestinal colonization independently increases PEBTI risk. The observed associations appear to be largely confounded by patient vulnerability factors, with no significant evidence of mediation by antibiotic prophylaxis. These findings suggest prioritizing host-directed prevention strategies over pathogen-directed interventions in clinical practice.

Indexed as

Anti-Bacterial AgentsAntibiotic ProphylaxisCholangiopancreatography, Endoscopic RetrogradeIntestinesAgedFemaleHumansMaleMiddle AgedProspective StudiesRisk FactorsAnti-Bacterial AgentsAntibiotic prophylaxisCausal inferenceIntestinal colonizationMediation analysisPost-ERCP biliary tract infection

Identifiers

PMID41634842
PMCPMC12958688

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.