Sahu Manoj Kumar, Chacko Ashok, Dutta Amit Kumar, Prakash John Antony Jude
Department of Gastrointestinal Sciences, Christian Medical College, Vellore 632 004, India.
Indian J Gastroenterol. 2011 Sep;30(5):204-8. doi: 10.1007/s12664-011-0135-3. Epub 2011 Oct 18.
The changing antimicrobial sensitivity pattern of causative organisms poses a therapeutic challenge in treating patients with acute cholangitis. We therefore evaluated the microbial profile and sensitivity pattern to antibiotics in patients with acute bacterial cholangitis.
Data of patients above 18 years of age with acute bacterial cholangitis seen between January 2004 and March 2007 were retrospectively analyzed. The study was continued prospectively from April 2007 to December 2008. Data on clinical features, etiological and microbial profile and therapy, and patient outcomes were analyzed. In the prospective group, the antibiotic susceptibility patterns of organisms grown on bile and blood culture were also obtained.
One hundred and eighty-five patients with acute cholangitis were studied. Choledocholithiasis (62.7%) and malignancy (29.2%) were the main predisposing factors. Bile culture was positive in 88 of 95 patients, and blood culture was positive in 47 of 178 (26.4%) patients. Bile cultures were predominantly polymicrobial (69.5%) in contrast to blood cultures (2.2%). E. coli was the predominant isolate in blood and bile. No growth was seen on anaerobic bile or blood cultures. The prospective group showed high resistance of E. coli to third generation cephalosporins and ciprofloxacin.
Changing antimicrobial sensitivity patterns requires a revision of empiric antibiotic therapy policy in cholangitis.
致病微生物不断变化的抗菌敏感性模式给急性胆管炎患者的治疗带来了挑战。因此，我们评估了急性细菌性胆管炎患者的微生物谱及对抗生素的敏感性模式。
回顾性分析2004年1月至2007年3月期间就诊的18岁以上急性细菌性胆管炎患者的数据。该研究于2007年4月至2008年12月继续进行前瞻性研究。分析了临床特征、病因及微生物谱、治疗方法和患者预后等数据。在前瞻性研究组中，还获取了胆汁和血培养中生长的微生物的抗生素敏感性模式。
共研究了185例急性胆管炎患者。胆总管结石（62.7%）和恶性肿瘤（29.2%）是主要的诱发因素。95例患者中88例胆汁培养呈阳性，178例患者中47例（26.4%）血培养呈阳性。与血培养（2.2%）相比，胆汁培养主要为多种微生物感染（69.5%）。大肠杆菌是血液和胆汁中最主要的分离菌。厌氧胆汁或血培养均未发现细菌生长。前瞻性研究组显示大肠杆菌对第三代头孢菌素和环丙沙星耐药性较高。
抗菌敏感性模式的变化需要修订胆管炎经验性抗生素治疗策略。
