Institute of Medical Microbiology, Immunology and Hygiene, Technische Universität München, München, Germany.
J Antimicrob Chemother. 2014 Feb;69(2):519-25. doi: 10.1093/jac/dkt373. Epub 2013 Oct 1.
To assess the risk factors for increased antimicrobial resistance among Enterobacteriaceae representing the most common biliary pathogens.
A retrospective analysis was conducted of 276 patients with acute cholangitis treated at a German tertiary centre between April 1996 and May 2009. The resistance patterns among Enterobacteriaceae isolated from blood/bile cultures were compared and related to age, sex, the genesis of the cholangitis and the type and number of previous interventional procedures [percutaneous transhepatic cholangiography (PTC)/endoscopic retrograde cholangiography (ERC)]. Univariate and multivariate generalized estimation equation models were used to compute ORs with corresponding 95% CIs for the binomial outcomes.
According to the univariate analysis, patients undergoing stent therapy had a smaller proportion of Enterobacteriaceae with susceptibility to quinolones (ofloxacin/ciprofloxacin) (184/239 versus 205/221; P < 0.001) and to ceftriaxone (208/239 versus 209/222; P = 0.014). Logistic regression analysis revealed that the odds for acquiring ceftriaxone-resistant Enterobacteriaceae were 4-fold higher than in patients who had not undergone stent therapy (P = 0.039). Furthermore, an increased number of interventional procedures (PTC/ERC) was associated with lower susceptibility. The odds for susceptibility to ampicillin, ampicillin/sulbactam, ceftriaxone, quinolones and co-trimoxazole decreased by 2%, 2%, 4%, 6% and 3%, respectively, per interventional procedure. Age, sex and type of interventional procedure displayed no significant relationship to the development of antimicrobial resistance.
Stent therapy was found to be a risk factor for increased antimicrobial resistance in patients with acute cholangitis, particularly those who had undergone numerous interventional procedures prior to the onset of the cholangitis.
评估引起常见胆道病原体肠杆菌科出现耐药性增加的危险因素。
对 1996 年 4 月至 2009 年 5 月期间在德国一家三级中心接受治疗的 276 例急性胆管炎患者进行回顾性分析。比较血/胆汁培养中分离出的肠杆菌科的耐药模式，并将其与年龄、性别、胆管炎的发病机制以及先前介入治疗的类型和次数[经皮经肝胆管造影术（PTC）/逆行胰胆管造影术（ERC）]相关联。使用单变量和多变量广义估计方程模型计算二项式结果的 OR 及其相应的 95%置信区间。
根据单变量分析，接受支架治疗的患者中对喹诺酮类（氧氟沙星/环丙沙星）（205/221 对 184/239；P<0.001）和头孢曲松（209/222 对 208/239；P=0.014）敏感的肠杆菌科比例较小。逻辑回归分析显示，与未接受支架治疗的患者相比，获得头孢曲松耐药肠杆菌科的几率高 4 倍（P=0.039）。此外，介入治疗次数（PTC/ERC）的增加与较低的敏感性相关。与每增加一次介入治疗相比，对氨苄西林、氨苄西林/舒巴坦、头孢曲松、喹诺酮类和复方磺胺甲噁唑的敏感性分别降低 2%、2%、4%、6%和 3%。年龄、性别和介入治疗类型与抗菌药物耐药性的发展无显著关系。
支架治疗被发现是急性胆管炎患者出现耐药性增加的一个危险因素，特别是那些在胆管炎发作前已接受多次介入治疗的患者。
