Department of Interventional Therapy, Tinajin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China.
Cardiovasc Intervent Radiol. 2012 Oct;35(5):1136-44. doi: 10.1007/s00270-011-0263-2. Epub 2011 Sep 9.
To assess the information obtained by bile culture and susceptibility testing for malignant biliary obstruction by a retrospective one-center study.
A total of 694 patients with malignant biliary obstruction received percutaneous transhepatic biliary drainage during the period July 2003 to September 2010, and subsequently, bile specimens were collected during the procedure. Among the 694 patients, 485 were men and 209 were women, ranging in age from 38 to 78 years (mean age 62 years).
A total of 42.9% patients had a positive bile culture (298 of 694). Further, 57 species of microorganisms and 342 strains were identified; gram-positive bacteria accounted for 50.9% (174 of 342) and gram-negative bacteria accounted for 41.5% (142 of 342) of these strains. No anaerobes were obtained by culture during this study. The most common microorganisms were Enterococcus faecalis (41 of 342, 11.9%), Escherichia coli (34 of 342, 9.9%), Klebsiella pneumoniae (28 of 342, 8.2%), Staphylococcus epidermidis (19 of 342, 5.5%), Enterococcus (18 of 342, 5.3%), and Enterobacter cloacae (16 of 342, 4.7%). The percentage of β-lactamase-producing gram-positive bacteria was 27.6% (48 of 174), and the percentage of gram-negative bacteria was 19.7% (28 of 142). The percentage of enzyme-producing Escherichia coli was 61.7% (21 of 34).
The bile cultures in malignant biliary obstruction are different from those in the Tokyo Guidelines and other benign biliary obstruction researches, which indicates that a different antibacterial therapy should be applied. Thus, knowledge of the antimicrobial susceptibility data could aid in the better use of antibiotics for the empirical therapy of biliary infection combined with malignant biliary obstruction.
通过回顾性单中心研究评估恶性胆道梗阻患者胆汁培养和药敏试验获得的信息。
2003 年 7 月至 2010 年 9 月期间，共有 694 例恶性胆道梗阻患者接受经皮经肝胆道引流术，随后在该过程中收集胆汁标本。694 例患者中，男 485 例，女 209 例，年龄 38 至 78 岁（平均年龄 62 岁）。
共有 42.9%的患者胆汁培养阳性（298/694）。此外，鉴定出 57 种微生物和 342 株菌；革兰阳性菌占 50.9%（174/342），革兰阴性菌占 41.5%（142/342）。本研究未培养出厌氧菌。最常见的微生物是粪肠球菌（342 株中的 41 株，11.9%）、大肠埃希菌（342 株中的 34 株，9.9%）、肺炎克雷伯菌（342 株中的 28 株，8.2%）、表皮葡萄球菌（342 株中的 19 株，5.5%）、肠球菌（342 株中的 18 株，5.3%）和阴沟肠杆菌（342 株中的 16 株，4.7%）。产β-内酰胺酶的革兰阳性菌比例为 27.6%（174 株中的 48 株），革兰阴性菌比例为 19.7%（142 株中的 28 株）。产酶大肠埃希菌的比例为 61.7%（34 株中的 21 株）。
恶性胆道梗阻患者的胆汁培养与东京指南和其他良性胆道梗阻研究中的培养不同，这表明应应用不同的抗菌治疗。因此，了解抗菌药物敏感性数据有助于更好地利用抗生素对合并恶性胆道梗阻的胆道感染进行经验性治疗。
