Karpel Ewa, Madej Andrzej, Bułdak Łukasz, Duława-Bułdak Anna, Nowakowska-Duława Ewa, Łabuzek Krzysztof, Haberka Maciej, Stojko Rafał, Okopień Boguslaw
Department of Anesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland.
Scand J Gastroenterol. 2011 Jul;46(7-8):925-30. doi: 10.3109/00365521.2011.560676. Epub 2011 Apr 20.
Cholangitis and biliary sepsis are severe infectious diseases, which are often observed in patients with choledocholithiasis. The antimicrobial therapy is effective if started as soon as the diagnosis is made. Therefore, the profile of bile pathogens and its susceptibility to a number of antibiotics were evaluated.
Bile cultures and antibiograms from 92 patients hospitalized between January 2006 and December 2008 in a tertiary referral center for the treatment of biliary and pancreatic diseases (Central Teaching Hospital, Medical University of Silesia) were reviewed. Specimens were obtained from patients with acute cholangitis and confirmed choledocholithiasis during endoscopic (i.e. ERCP) and surgical (i.e. percutaneus transhepatic biliary drainage) procedures. The bile specimens were examined for pathogenic aerobic and anaerobic bacteria and fungi.
Sixty-five of 92 analyzed cultures were positive. A total of 69 pathogens were isolated: 47 (68.1%) gram-negative bacteria, 18 (26.1%) gram-positive bacteria, 2 (2.9%) anaerobes and 2 (2.9%) Candida. The predominant gram-negative pathogens were Escherichia coli, Acinetobacter baumani complex, Klebsiella pneumoniae and Enterobacter cloacae. The most effective antibiotics against gram-negative bacteria were imipenem, cefoperazone/sulbactam, piperacillin/tazobactam and cefepime (susceptibility 97.9%, 89.4%, 85.1% and 85.1%, respectively). The expenditure on antibiotics monotherapies and combined therapies was also analyzed.
Our study shows that gram-negative bacteria were the predominant bile pathogens found in patients with acute cholangitis. Piperacillin/tazobactam or ceftazidime may be the alternative to ciprofloxacin therapeutic option. The addition of ticarcillin/clavulanic acid to ciprofloxacin could also be considered. However, imipenem should remain a back-up antibiotic in the treatment of acute cholangitis.
胆管炎和胆源性败血症是严重的感染性疾病，常见于胆总管结石患者。一旦确诊即开始抗菌治疗是有效的。因此，对胆汁病原体的特征及其对多种抗生素的敏感性进行了评估。
回顾了2006年1月至2008年12月期间在一家三级转诊中心（西里西亚医科大学中央教学医院）住院治疗胆道和胰腺疾病的92例患者的胆汁培养和药敏试验结果。标本取自急性胆管炎且确诊为胆总管结石的患者，在内镜检查（即内镜逆行胰胆管造影术）和外科手术（即经皮经肝胆道引流）过程中获取。对胆汁标本进行需氧和厌氧病原菌及真菌检查。
92份分析培养物中有65份呈阳性。共分离出69种病原体：47种（68.1%）革兰阴性菌，18种（26.1%）革兰阳性菌，2种（2.9%）厌氧菌和2种（2.9%）念珠菌。主要的革兰阴性病原体为大肠埃希菌、鲍曼不动杆菌复合体、肺炎克雷伯菌和阴沟肠杆菌。对革兰阴性菌最有效的抗生素是亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和头孢吡肟（敏感性分别为97.9%、89.4%、85.1%和85.1%）。还分析了抗生素单一疗法和联合疗法的费用。
我们的研究表明，革兰阴性菌是急性胆管炎患者中主要的胆汁病原体。哌拉西林/他唑巴坦或头孢他啶可能是环丙沙星治疗方案的替代选择。也可考虑在环丙沙星中添加替卡西林/克拉维酸。然而，亚胺培南在急性胆管炎治疗中仍应作为备用抗生素。
