Illés Dóra, Urbán Edit, Lázár Andrea, Nagy Kamilla, Ivány Emese, Kui Balázs, Lemes Klára, Tajti Máté, Czakó László
I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720.
Klinikai Mikrobiológiai Diagnosztikai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged.
Orv Hetil. 2019 Sep;160(36):1437-1442. doi: 10.1556/650.2019.31456.
Due to the inappropriate use of antibiotics (AB), more pathogens become multiresistant. One of the most severe sources of sepsis is cholangitis. To avoid fatal outcome, an effective AB policy plays a key role. To investigate the AB resistance of bacteria causing cholangitis and the efficacy of AB treatment. Microbiological tests of bile samples collected during cholangitis-indicated endoscopic retrograde cholangiopancreatographies were analysed at the First Department of Medicine, University of Szeged, in 2006 and in 2016. 29 and 111 patients had bile sample collection in 2006 and in 2016, respectively. Of that, 22 (75%) and 106 (95%) were positive. Mean age: 61 ± 14 vs. 71 ± 14 years, no difference between men/women ratio. In 2006, 10 cases empirical AB (ciprofloxacine with metronidazole or imipenem) were used. In 9 cases (90%), the AB was adequate based on the microbiological results. In 2016, in 88 cases empirical AB was applied (ciprofloxacine and metronidazole, ceftriaxone with metronidazole or imipenem with metronidazole). In 29 cases, the empirical AB was ineffective. The efficacy of ciprofloxacine decreased to 64% in 2016. The profile of the most frequent cholangitis-causing pathogens was the same, but their resistency against ciprofloxacine increased. The rates of polymicrobal infections were 73% and 63%, respectively. The rates of positive bile samples were significantly higher in 2016. The profile of the most frequent pathogens was the same. The efficacy of the first-choice empirical AB ciprofloxacine decreased in 2016. The types of the most frequent cholangitis-causing bacteria are in line with the ones included in the Tokyo Guideline. Orv Hetil. 2019; 160(36): 1437-1442.
由于抗生素的不当使用，更多病原体产生了多重耐药性。胆管炎是脓毒症最严重的来源之一。为避免致命后果，有效的抗生素政策起着关键作用。为了研究引起胆管炎的细菌的抗生素耐药性以及抗生素治疗的效果。2006年和2016年在塞格德大学第一医学部对在胆管炎相关的内镜逆行胰胆管造影术中采集的胆汁样本进行了微生物学检测。2006年和2016年分别有29例和111例患者采集了胆汁样本。其中，2006年22例（75%）、2016年106例（95%）呈阳性。平均年龄：2006年为61±14岁，2016年为71±14岁，男女比例无差异。2006年，10例患者使用了经验性抗生素（环丙沙星联合甲硝唑或亚胺培南）。根据微生物学结果，9例（90%）患者使用的抗生素是合适的。2016年，88例患者应用了经验性抗生素（环丙沙星和甲硝唑、头孢曲松联合甲硝唑或亚胺培南联合甲硝唑）。29例患者经验性使用的抗生素无效。2016年环丙沙星的疗效降至64%。最常见的引起胆管炎的病原体谱相同，但它们对环丙沙星的耐药性增加。多微生物感染率分别为73%和63%。2016年胆汁样本阳性率显著更高。最常见病原体谱相同。2016年首选经验性抗生素环丙沙星的疗效下降。最常见的引起胆管炎的细菌类型与《东京指南》中的一致。《匈牙利医学周报》。2019年；160(36):1437 - 1442。
