Department of Medicine II, University Hospital, LMU Munich, Munich, Germany,
Liver Center, University Hospital, LMU Munich, Munich, Germany,
Dig Dis. 2021;39(1):42-51. doi: 10.1159/000509289. Epub 2020 Jun 10.
Acute cholangitis is a life-threatening condition. The early initiation of antibiotic therapy significantly impacts the course of disease. Only few data are available on distribution and resistance profiles of bile pathogens. Here, we report on an analysis of routinely acquired bile specimens and provide an overview of the prevalence, resistance rates, and risk factors for the presence of pathogens in bile.
Bile cultures obtained from 388 endoscopic retrograde cholangiographies (ERCs) with corresponding clinical data were analysed in 208 patients.
The majority (84.8%) of cultures yielded positive for at least 1 organism. Abundance was highest for Enterococcus faecalis, Enterococcus faecium, and Escherichia coli. Multiresistant organisms were present in 14.9%. The initial antibiotic regimen was changed in 44.1%, which increased the length of hospital stay significantly (***p < 0.001). Pre-existing papillotomy (EPT) or biliary drainage was associated with higher frequency of bile pathogens (**p < 0.01) in a univariate analysis. Multivariate analysis confirmed these results for EPT and revealed significantly more positive results for pathogens, gram-negative bacteria, and fungi in patients with biliary drainage. Significant differences in the prevalence of pathogens were observed between relevant subgroups of ERC indications. The highest susceptibility rates were observed for linezolid and tigecycline in gram-positive bacteria and for meropenem and gentamicin in gram-negative bacteria.
Our study provides a comprehensive analysis of the distribution, resistance profiles, and risk factors for the detection of bile pathogens. The frequent change in initial antibiotic treatment highlights the importance of routine bile culture and indicates that current schemas of empirical treatment might not cover the contemporary spectrum of pathogens in bile.
急性胆管炎是一种危及生命的疾病。早期开始使用抗生素治疗对疾病的进程有重大影响。关于胆汁病原体的分布和耐药谱的数据很少。在这里，我们报告了一项对常规获得的胆汁标本的分析，并提供了胆汁中病原体存在的患病率、耐药率和危险因素的概述。
对 388 例经内镜逆行胰胆管造影术（ERCP）获得的 208 例患者的胆汁培养物及其相应的临床数据进行了分析。
大多数（84.8%）培养物至少有一种细菌阳性。肠球菌属（Enterococcus faecalis、Enterococcus faecium）和大肠杆菌（Escherichia coli）的丰度最高。存在多药耐药菌的比例为 14.9%。初始抗生素方案发生改变的比例为 44.1%，这显著延长了住院时间（***p < 0.001）。单因素分析显示，既往经皮肝穿刺胆道引流术（PTBD）或胆道引流与胆汁病原体的检出频率较高相关（**p < 0.01）。多因素分析证实了经皮肝穿刺胆道引流术（PTBD）的这些结果，并显示出胆道引流患者的病原体、革兰氏阴性菌和真菌的阳性结果显著更多。在 ERC 适应证的相关亚组中观察到病原体的患病率存在显著差异。革兰氏阳性菌中对利奈唑胺和替加环素的敏感性最高，革兰氏阴性菌中对美罗培南和庆大霉素的敏感性最高。
我们的研究提供了胆汁病原体的分布、耐药谱和检测风险因素的综合分析。初始抗生素治疗的频繁改变突出了常规胆汁培养的重要性，并表明当前经验性治疗方案可能无法涵盖当代胆汁病原体的范围。
