细菌和真菌与肝移植术后内镜治疗胆道并发症患者的结局相关。

Bacteriobilia and fungibilia are associated with outcome in patients with endoscopic treatment of biliary complications after liver transplantation.

机构信息

Department of Gastroenterology, Toxicology, and Infectious Diseases, University Hospital of Heidelberg, Germany.

出版信息

Endoscopy. 2013 Nov;45(11):890-6. doi: 10.1055/s-0033-1344713. Epub 2013 Oct 28.

DOI:10.1055/s-0033-1344713

PMID:24165814

Abstract

BACKGROUND AND STUDY AIMS

To determine the importance of bacteriobilia and fungibilia in patients with endoscopic treatment of biliary complications after orthotopic liver transplantation (OLT).

PATIENTS AND METHODS

In a prospective study at a tertiary center, 213 patients underwent 857 endoscopic retrograde cholangiographies (ERCs) after OLT. Findings at first ERC were: anastomotic stricture in 24.4%, nonanastomotic stricture in 18.3%, leakage in 11.3%, and gallstones in 4.7%.

RESULTS

Bile samples from first ERC showed Gram-positive bacterial isolates in 102/180 (57%) and Gram-negative in 44/180 (24%). Main species were Enterococcus spp. (40%; 72/180) and Escherichia coli (10%; 18 /180). Enteric bacteria (present in 47%) and Candida spp. (present in 18%) were both associated with clinical signs of cholangitis, but not with laboratory signs of inflammation. Multiresistant strains (present in 12% of samples) showed no association with clinical or laboratory parameters. Detection of microbiological isolates was independent of endoscopic findings and treatment. In patients with successful endoscopic intervention, the actuarial survival free of retransplantation was significantly lower in those with detection of enteric bacteria, being 51.8 months (95% confidence interval [CI] 42.9-60.6) vs. 62.9 months (95% CI 59.1-66.7); P = 0.025). Fungibilia was associated with significantly lower actuarial retransplantation-free survival, independently of successful endoscopic treatment (mean 35.1 months [95% CI 23.5-46.7] vs. 53.1 months [(95% CI 48.0-58.2]; P = 0.019).

CONCLUSIONS

Bacteriobilia and fungibilia can frequently be detected by routine microbiological sampling in patients after OLT. Regular bile sampling is recommended since the presence of difficult-to-treat multiresistant strains is unpredictable. Survival is affected by this altered biliary microbiological environment after OLT.

摘要

背景和研究目的

确定细菌和真菌在原位肝移植（OLT）后胆道并发症内镜治疗患者中的重要性。

患者和方法

在一个三级中心的前瞻性研究中，213 名患者在 OLT 后进行了 857 次逆行胰胆管造影（ERC）。第一次 ERC 的发现：吻合口狭窄 24.4%，非吻合口狭窄 18.3%，漏液 11.3%，胆石 4.7%。

结果

第一次 ERC 的胆汁样本中，革兰阳性细菌分离株 102/180（57%），革兰阴性细菌分离株 44/180（24%）。主要菌种为肠球菌属（40%；72/180）和大肠杆菌（10%；18/180）。肠杆菌（47%）和念珠菌（18%）均与胆管炎的临床征象相关，但与炎症的实验室征象无关。多耐药株（占样本的 12%）与临床或实验室参数无关。微生物分离株的检出与内镜发现和治疗无关。在内镜治疗成功的患者中，检测到肠杆菌的患者无再次移植的生存 actuarial 率明显较低，分别为 51.8 个月（95%置信区间[CI] 42.9-60.6）和 62.9 个月（95%CI 59.1-66.7）；P = 0.025）。真菌血症与独立于成功的内镜治疗的显著较低的无再移植生存 actuarial 率相关（平均 35.1 个月[95%CI 23.5-46.7]与 53.1 个月[95%CI 48.0-58.2]；P = 0.019）。