Minami Tomoyuki, Sasaki Tamito, Serikawa Masahiro, Ishigaki Takashi, Murakami Yoshiaki, Chayama Kazuaki
Department of Gastroenterology and Metabolism, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
J Hepatobiliary Pancreat Sci. 2014 Sep;21(9):712-8. doi: 10.1002/jhbp.129. Epub 2014 Jun 13.
No consensus has yet been reached regarding the utility of antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP). However, there has been little discussion of potential adverse effects of antibiotic use. This study investigated the impact of antibiotic prophylaxis on overall levels of bacterial infiltration of the biliary tract and the prevalence of drug-resistance among that population.
Ninety-three patients, from whom intraoperative bile samples were collected after performing ERCP, were assigned to either an antibiotic-prophylaxis group (AP, n = 58) or a no-antibiotic-prophylaxis group (NAP, n = 35). Detection rates of biliary bacteria and antibiotic resistance were determined for each group. Multivariate analysis was also performed to identify risk factors for the development of drug-resistant biliary bacteria.
The bile contamination rate was 37.1% for the NAP group and 55.2% for the AP group (P = 0.09). Drug-resistant bacteria were found in 5.7% of the NAP group and 29.3% of the AP group (P = 0.006). Biliary drainage and antibiotic prophylaxis for ERCP were identified as risk factors for the presence of drug-resistant bacteria.
Administration of antibiotic prophylaxis prior to ERCP can be a risk factor for the selection of drug-resistant bacteria in the biliary tract.
关于内镜逆行胰胆管造影术（ERCP）预防性使用抗生素的效用尚未达成共识。然而，对于抗生素使用的潜在不良反应讨论甚少。本研究调查了预防性使用抗生素对胆道细菌浸润总体水平以及该人群中耐药性流行情况的影响。
93例患者在接受ERCP后术中采集胆汁样本，被分为预防性使用抗生素组（AP，n = 58）和未预防性使用抗生素组（NAP，n = 35）。测定每组的胆道细菌检出率和抗生素耐药性。还进行了多变量分析以确定耐药胆道细菌发生的危险因素。
NAP组胆汁污染率为37.1%，AP组为55.2%（P = 0.09）。NAP组中发现5.7%的患者有耐药菌，AP组为29.3%（P = 0.006）。ERCP的胆道引流和预防性使用抗生素被确定为存在耐药菌的危险因素。
ERCP术前预防性使用抗生素可能是胆道中选择耐药菌的一个危险因素。
