Department of Medicine, Division of Gastroenterology, Sungkyunkwan University School of Medicine, Seoul, Korea.
Am J Gastroenterol. 2012 Mar;107(3):473-83. doi: 10.1038/ajg.2011.387. Epub 2012 Feb 14.
The prevalence of antibiotic-resistant pathogens continues to increase steadily. The aim of this study was to analyze the changing patterns and risk factors of antibiotic resistance in patients with bacteremic biliary tract infections (BTIs). In addition, prognostic factors related to survival in patients with a bacteremic BTI were evaluated.
Five hundred fifty-six biliary bacteremic events in 411 patients, treated from January 2000 to April 2010, were retrospectively analyzed. In addition, biliary bacteremic events were divided into nosocomial infections (N=396) and community-acquired infections (N=160).
The resistance rate to third-generation cephalosporin was higher in 2005-2009 (35 out of 140, 25%, vs. 72 out of 151, 47.7%). The prevalence of extended-spectrum β-lactamase-producing organisms of Escherichia coli and Klebsiella strains increased markedly from 2.3% (2 out of 86) in 2000-2004 to 43.9% (58 out of 132) in 2005-2009. Nosocomial infection, hospital days before bacteremia, previous hospitalization within 90 days, previous use of antibiotics within 90 days, and an indwelling biliary drainage catheter were found to be independently associated with antibiotic resistance. However, no association was found between antibiotic resistance and mortality in patients with biliary bacteremia.
Antibiotic resistance in bacteremic BTI has increased markedly during the past 10 years. Almost half of nosocomial bacteremic BTI caused by common Gram-negative pathogens during 2005-2009 (58.5%) could not be treated with third-generation cephalosporin. Clinical outcomes were found to be associated with bacteremia severity and underlying illness rather than antibiotic resistance.
抗生素耐药病原体的流行率持续稳步上升。本研究旨在分析菌血症性胆道感染（BTI）患者的抗生素耐药性变化模式和危险因素。此外，还评估了与菌血症性 BTI 患者生存相关的预后因素。
回顾性分析了 2000 年 1 月至 2010 年 4 月期间 411 例患者的 556 例胆道菌血症事件。此外，将胆道菌血症事件分为医院获得性感染（N=396）和社区获得性感染（N=160）。
2005-2009 年第三代头孢菌素的耐药率较高（35/140，25%，vs. 72/151，47.7%）。产超广谱β-内酰胺酶的大肠埃希菌和克雷伯菌属的流行率从 2000-2004 年的 2.3%（86 例中的 2 例）显著上升至 2005-2009 年的 43.9%（132 例中的 58 例）。医院获得性感染、菌血症前住院天数、90 天内既往住院、90 天内既往使用抗生素和留置胆道引流管被发现与抗生素耐药性独立相关。然而，在胆道菌血症患者中，抗生素耐药性与死亡率之间没有关联。
在过去的 10 年中，菌血症性 BTI 的抗生素耐药性显著增加。2005-2009 年期间，近一半的由常见革兰氏阴性病原体引起的医院获得性菌血症性 BTI（58.5%）不能用第三代头孢菌素治疗。临床结局与菌血症严重程度和基础疾病有关，而与抗生素耐药性无关。
