Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.
Gut Liver. 2022 Nov 15;16(6):985-994. doi: 10.5009/gnl210474. Epub 2022 Mar 24.
BACKGROUND/AIMS: To select appropriate empirical antibiotics, updates on the changes in pathogens are essential. We aimed to investigate the changes in pathogens and their antibiotic susceptibility in acute cholangitis (AC) with bacteremia over a period of 15 years. Furthermore, the efficacy of empirical antibiotic therapies and the risk factors predicting antibiotic-resistant pathogens (ARPs) were analyzed.
A total of 568 patients with AC and bacteremia who were admitted to Daegu Catholic University Medical Center from January 2006 to December 2020 were included. Their medical records were retrospectively reviewed. In addition, the data were grouped and analyzed at 3-year intervals under the criteria of Tokyo Guideline 2018.
During the study period, 596 pathogens were isolated from blood cultures of 568 patients. The three most common pathogens were (50.5%), species (24.5%), and species (8.1%). The proportion of vancomycin-resistant (VRE) has increased since the mid-2010 (0.0% to 4.3%, p=0.007). There was emergence of carbapenem-resistant (CRE) in 2018 to 2020, albeit not statistically significant (1.3%, p=0.096). Risk factors predicting ARP were healthcare-associated infection, history of previous biliary intervention, and the severity of AC. For patients with these aforementioned risk factors, imipenem was the most effective antibiotic and piperacillin-tazobactam was also effective but to a lesser degree (susceptibility rates of 92.1% and 75.0%, respectively).
The proportion of VRE has increased and CRE has emerged in AC. In addition, healthcare-associated infection, history of previous biliary intervention, and the severity of AC were independent risk factors predicting ARP. For patients with these risk factors, the administration of imipenem or piperacillin-tazobactam should be considered.
背景/目的：为了选择合适的经验性抗生素，了解病原体的变化至关重要。本研究旨在调查 15 年来伴有菌血症的急性胆管炎（AC）患者中病原体及其抗生素敏感性的变化，并分析经验性抗生素治疗的疗效和预测抗生素耐药病原体（ARPs）的危险因素。
回顾性分析 2006 年 1 月至 2020 年 12 月期间因 AC 伴菌血症入住大邱天主教大学医疗中心的 568 例患者的病历资料。根据 2018 年东京指南的标准，将数据分为 3 年一组进行分析。
在研究期间，从 568 例患者的血培养中分离出 596 株病原体。最常见的三种病原体分别是 （50.5%）、 种（24.5%）和 种（8.1%）。自 2010 年年中以来，耐万古霉素的 （VRE）的比例有所增加（0.0%至 4.3%，p=0.007）。2018 年至 2020 年期间出现了耐碳青霉烯类肠杆菌科细菌（CRE），但无统计学意义（1.3%，p=0.096）。预测 ARP 的危险因素包括医源性感染、既往胆道干预史和 AC 的严重程度。对于具有上述危险因素的患者，亚胺培南是最有效的抗生素，哌拉西林-他唑巴坦也有效，但效果稍差（分别为 92.1%和 75.0%的敏感性）。
AC 中 VRE 的比例增加，CRE 出现。此外，医源性感染、既往胆道干预史和 AC 的严重程度是预测 ARP 的独立危险因素。对于具有这些危险因素的患者，应考虑使用亚胺培南或哌拉西林-他唑巴坦。
