Polymicrobial Biliary Tract Infections and Carbapenem Susceptibility: A 10-Year Retrospective Analysis Guiding Surgical Antimicrobial Stewardship

Background Biliary infections and cholangitis represent a significant clinical challenge, particularly among the aging population, and can lead to considerable morbidity and mortality. Current therapeutic modalities, including endoscopic retrograde cholangiopancreatography (ERCP) and antibiotic regimens, exhibit notable limitations in efficacy, thereby necessitating the exploration of alternative intervention strategies that are more effective against these infections. Methods This study aimed to conduct a retrospective analysis of 889 patients diagnosed with biliary infections to elucidate the microbial characteristics and antibiotic susceptibility profiles present in this cohort. Comprehensive culturing techniques were employed to isolate microbial agents from bile samples, whilst patient demographics, clinical outcomes, and resistance patterns were systematically evaluated. Results Among the analyzed cases, a male predominance (57.8%) was noted, with a mean age of 66.54 years; importantly, the number of cases has exhibited an upward trend in recent years. The bile culture positivity rate reached 88.3%, with a notable incidence of polymicrobial infections at 56.05%. A total of 1421 microbial strains were identified, predominantly comprising Gram-negative bacilli, with Escherichia coli and Klebsiella pneumoniae showing significant antibiotic resistance, although retained susceptibility to carbapenems. Notably, the patients demonstrated good tolerance towards surgical interventions without severe complications. Conclusion The findings of this study underscore the critical implications of polymicrobial infections and antibiotic resistance in the clinical management of biliary infections. Increased vigilance towards co-infections is warranted, and the results provide essential insights for future antibiotic stewardship strategies. Looking ahead, we advocate for further mechanistic investigations, ideally integrating experimental laboratory studies, to refine and optimize therapeutic approaches for biliary infections.