To compare the nosocomial infection rates and clinical efficacy between biliary stent loaded with radioactive ¹²⁵I seeds strip (combined group) and conventional biliary stent (conventional group) in the treatment of malignant biliary obstruction.

Clinical data of128 patients (70 in the combined group and 58 in the conventional group) admitted to Lishui Municipal Central Hospital due to MBO who underwent percutaneous transhepatic cholangial drainage (PTCD) with sequential biliary stent implantation from April 2019 to June 2022 were retrospectively collected. Bile specimens were collected from all patients during PTCD, and relevant indicators and adverse events were monitored postoperatively. The incidence of nosocomial infection, rate of postoperative total bilirubin decline, stent patency time, and incidence of adverse events were analyzed for both groups.

There was no statistically significant difference observed in the Nosocomial Infection Rate between the two groups (8.5% vs 8.6%; P > 0.05). Notably, patients with a white blood cell count (WBC) exceeding 10 × 10⁹/L exhibited a significantly higher rate of positive bile culture during PTCD in comparison to those with a WBC count of ≤10 × 10⁹/L (48% vs 26.2%; P < 0.05). Among the 128 patients, a total of 39 (39/128) displayed positive results in bile culture. The top three pathogens identified were Klebsiella pneumoniae (n=13; 32%), Escherichia coli (n=9; 22%), Pseudomonas aeruginosa (n=7; 18%). Furthermore, the combined group demonstrated a notably more rapid decrease in total bilirubin levels compared to the conventional group (7.1 days vs 11.2 days; P < 0.05). The median duration of biliary stent patency in the combined group was 5.9 months (95%CI: 5-7 months), while in the conventional group, it was 2.6 months (95%CI: 2~4 months). The difference in stent patency duration between the two groups was statistically significant (P < 0.05).

The combined group exhibited no increase in the Nosocomial Infection Rate. Moreover, it demonstrated superior clinical efficacy with a high level of safety. Patients presenting with WBC count greater than 10 × 10⁹/L before PTCD displayed a notably higher positive rate in intraoperative bile culture, and early use of antibiotics was recommended. The predominant pathogens identified in biliary tract infections were Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa.