In the management of congenital biliary atresia (CBA), postoperative ascending cholangitis is one of the most serious complications which affect the prognosis. At our department, 45 cases of CBA have been experienced since 1972. In these patients, E. coli and Klebsiella had been thought as pathogens of ascending cholangitis. However, these have been seen in fewer number of cases. Instead of these strains, Enterobacter, Acinetobacter and Pseudomonas cepacia have recently often been detected from the enterostomy content in patients of ascending cholangitis. One of the causes of this alternation seems to be due to the antibiotics which have been usually used. For example, Cefazolin is sensitive to E. coli and Klebsiella, but not to Enterobacter, Acinetobacter, and Pseudomonas cepacia. In addition, many strains of Entrobacter have been resistant to gentamicin. The other cause of exchange of pathogens is thought to be due to disinfectants which are often used. In these years, the numbers of Hibitane resistant strains have increased. (i.e., Acinetobacter, Pseudomonas cepacia). At our department, Hibitane has often been used and then Hibitane resistant-strains are thought to increase. Both the bacterial killing activity and the superoxide production of neutrophils in patients of CBA were depressed, suggesting susceptibility to infection. By these observations, the choice of chemotherapeutics for prevention of cholangitis in CBA seems very important.
