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The microbiota of the bilio-pancreatic system: a cohort, STROBE-compliant study

Authors Di Carlo P, Serra N, D'Arpa F, Agrusa A, Gulotta G, Fasciana T, Rodolico V, Giammanco A, Sergi C

Received 4 January 2019

Accepted for publication 13 April 2019

Published 11 June 2019 Volume 2019:12 Pages 1513—1527


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Sahil Khanna

Paola Di Carlo,1 Nicola Serra,2 Francesco D’Arpa,3 Antonino Agrusa,3 Gaspare Gulotta,3 Teresa Fasciana,1 Vito Rodolico,1 Anna Giammanco,1 Consolato Sergi4,5

1Department of Sciences for Health Promotion, Mother & Child Care, University of Palermo, Palermo, Italy; 2Statistic Unit, Department of Public Health, University of Naples ‘Federico II’, Naples, Italy; 3Department of General Surgery and Emergency, University of Palermo, Palermo, Italy; 4Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada; 5Department of Laboratory Medicine and Pathology, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada

Background: The gut microbiota play an essential role in protecting the host against pathogenic microorganisms by modulating immunity and regulating metabolic processes. In response to environmental factors, microbes can hugely alter their metabolism. These factors can substantially impact the host and have potential pathologic implications.  Particularly pathogenic microorganisms colonizing pancreas and biliary tract tissues may be involved in chronic inflammation and cancer evolution.
Purpose: To evaluate the effect of bile microbiota on survival in patients with pancreas and biliary tract disease (PBD).
Patients and Methods: We investigated 152 Italian patients with cholelithiasis (CHL), cholangitis (CHA), cholangiocarcinoma (CCA), gallbladder carcinoma (GBC), pancreas head carcinoma (PHC), ampullary carcinoma (ACA), and chronic pancreatitis (CHP). Demographics, bile cultures, therapy, and survival rates were analyzed in cohorts (T1 death <6 months; T2 death <12 months; T3 death <18 months, T3S alive at 18 months).
Results: The most common bacteria in T1 were E. coli, K. pneumoniae, and P. aeruginosa. In T2, the most common bacteria were E. coli and P. aeruginosa. In T3, there were no significant bacteria isolated, while in T3S the most common bacteria were like those found in T1. E. coli and K. pneumoniae were positive predictors of survival for PHC and ACA, respectively. E. coli, K. pneumoniae, and P. aeruginosa showed a high percentage of resistant bacteria to 3CGS, aminoglycosides class, and quinolone group especially at T1 and T2 in cancer patients.
Conclusions: An unprecedented increase of E. coli in bile leads to a decrease in survival. We suggest that some strains isolated in bile samples may be considered within the group of risk factors in carcinogenesis and/or progression of hepato-biliary malignancy. A better understanding of bile microbiota in patients with PBD should lead to a multifaceted approach to rapidly detect and treat pathogens before patients enter the surgical setting in tandem with the implementation of the infection control policy.

Keywords: human bile microorganisms, survival, pancreatic and biliary tract disease, E. coli

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