Original Articles
In vitro evaluation of antibiotic prophylaxis in the prevention of biliary stent blockage,☆☆

Presented, in part, at Digestive Diseases Week, May 1995, San Diego, and May 1996, San Francisco, California.
https://doi.org/10.1016/S0016-5107(00)70358-0Get rights and content

Abstract

Background:  Bacterial adherence and biofilm formation are important factors in the blockage of biliary stents. Clinical studies with oral antibiotic prophylaxis to prevent stent blockage have produced conflicting results. The aim of this study was to evaluate the in vitro effect of single antibiotic (ciprofloxacin, ceftazidime, or ampicillin) treatment on adherence of Escherichia coli and Enterococcus to plastic stents. Methods:  Selected clinical isolates of E coli and Enterococcus were perfused through a modified Robbins device containing segments of polyethylene stents. The stents were removed daily and the number of bacteria attached was measured. The effect of antibiotic treatment on bacterial adherence was tested by the perfusion of individual antibiotics into separate modified Robbins devices using a side-arm adaptor and the results were compared with saline controls. Results:  Compared with the saline controls, ciprofloxacin and ceftazidime caused a 10- to 100-fold reduction in the number of E coli attached to the stents, whereas ampicillin had no effect on adherence of E coli . Ampicillin caused a 5- to 10-fold reduction in Enterococcus adherence but there was no change with ceftazidime. Sustained reduction in E coli adherence was observed with prolonged ciprofloxacin perfusion. Conclusion:  Timely treatment with appropriate antibiotics reduced bacterial adherence in vitro and may be potentially beneficial in the prevention of stent blockage. (Gastrointest Endosc 2000;51:296-303.)

Section snippets

Modified Robbins device

The MRD is an acrylic sampling device, 42 cm long with a 2 × 10 mm chamber (Fig. 1).

. Set up of modified Robbins device (MRD) which contains sampling ports attached to the flow chamber. Inset shows magnified view of stent piece attached to sampling port.

It has 25 evenly spaced sampling ports and is designed in such a way that the sampling surfaces lie flush with the inner surface of the flow chamber. In this experiment, segments of polyethylene stent were attached onto rubber discs using a

Effects of antibiotics on E coli adherence

In the control experiments, examination of the stents after perfusion with E coli infected ox bile revealed a dense bacterial biofilm on the plastic surface at 24 hours. The total number of bacteria continued to increase and stabilized after 2 days, reaching a density of 104 CFU/cm2 when measured with the viable plate count method. The bacterial density remained at this level up to the end of 1 week. With ciprofloxacin perfusion at a concentration of 1 μg/mL, the bacterial density of E coli

Discussion

Biliary biofilm formation involves a multitude of different bacteria and potential interactions between them. Some bacteria may prime the surface or facilitate the attachment of other bacteria.22 Such interaction may be through the production of glycocalyx or chemical signaling factors that stimulate bacterial adherence. Other bacteria may contribute to sludge formation through their enzymatic activities with production of glycocalyx. Those that possess β-glucuronidase deconjugated conjugated

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    Supported by VA Merit Review Grant, No. 94-07-003.

    ☆☆

    Reprint requests: Joseph W. Leung, MD, Division of Gastroenterology, University of California, Davis Medical Center, Ste 3500, PSSB, 4150 V St., Sacramento, CA 95817

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