Jahn Michael, Özçürümez Mustafa K, Dolff Sebastian, Rohn Hana, Heider Dominik, Dechêne Alexander, Canbay Ali, Rath Peter M, Katsounas Antonios
Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany.
J Clin Transl Hepatol. 2022 Oct 28;10(5):788-795. doi: 10.14218/JCTH.2021.00337. Epub 2022 Mar 21.
Polymerase chain reaction (PCR) techniques provide rapid detection of pathogens. This pilot study evaluated the diagnostic utility and clinical impact of multiplex real-time PCR (mRT-PCR, Septi) vs. conventional microbial culture (CMC) in bile samples of patients with chronic cholestatic liver diseases (cCLDs), endoscopic retrograde cholangio-pancreatography (ERCP), and peri-interventional-antimicrobial-prophylaxis (pAP).
We prospectively collected bile samples from 26 patients for microbiological analysis by CMC and mRT-PCR. Concordance of the results of both methods was determined by Krippendorff's alpha (α) for inter-rater reliability and the Jaccard index of similarity.
mRT-PCR and CMC results were concordant for only (α=0.8406; Jaccard index=0.8181). mRT-PCR detected pathogens in 8/8 cases (100%), CMC in 7/8 (87.5%), and CMC in 5/8 (62.5%) with clinical signs of infection. mRT-PCR, CMC, and CMC had identical detection results in 3/8 (37.5%) with clinical signs of infection (two spp. and one ). The total pathogen count was significantly higher with mRT-PCR than with CMC (62 vs. 31; χ=30.031, <0.001). However, pathogens detected by mRT-PCR were more often susceptible to pAP according to the patient infection/colonization history (PI/CH) and surveillance data for antibiotic resistance in our clinic (DARC). Pathogens identified by mRT-PCR and resistant to pAP by PI/CH and DARC were likely to be clinically relevant.
mRT-PCR in conjunction with CMCs for bile analysis increased diagnostic sensitivity and may benefit infection management in patients with cholestatic diseases. Implementation of mRT-PCR in a bile sample-based diagnostic routine can support more rapid and targeted use of antimicrobial agents in cCLD-patients undergoing ERCP and reduce the rate/length of unnecessary administration of broad-spectrum antibiotics.
聚合酶链反应（PCR）技术可快速检测病原体。本前瞻性研究评估了多重实时PCR（mRT-PCR，Septi）与传统微生物培养（CMC）在慢性胆汁淤积性肝病（cCLD）患者胆汁样本、内镜逆行胰胆管造影（ERCP）及围手术期抗菌预防（pAP）中的诊断效用及临床影响。
我们前瞻性收集了26例患者的胆汁样本，采用CMC和mRT-PCR进行微生物分析。两种方法结果的一致性通过Krippendorff's α（α）评估评分者间信度，以及Jaccard相似性指数来确定。
mRT-PCR和CMC结果仅在……时一致（α=0.8406；Jaccard指数=0.8181）。mRT-PCR在8/8例（100%）中检测到病原体，CMC在8/8例中的7例（87.5%）中检测到病原体，CMC在有感染临床体征的8/8例中的5例（62.5%）中检测到病原体。mRT-PCR、CMC和CMC在有感染临床体征的8/8例中的3例（37.5%）中检测结果相同（两种……菌属和一种……菌属）。mRT-PCR检测到的病原体总数显著高于CMC（62对31；χ=30.031，<0.001）。然而，根据患者感染/定植史（PI/CH）和我们诊所的抗生素耐药监测数据（DARC），mRT-PCR检测到的病原体对pAP更敏感。mRT-PCR鉴定出且根据PI/CH和DARC对pAP耐药的病原体可能具有临床相关性。
mRT-PCR联合CMC进行胆汁分析可提高诊断敏感性，可能有益于胆汁淤积性疾病患者的感染管理。在基于胆汁样本的诊断常规中实施mRT-PCR可支持对接受ERCP的cCLD患者更快速、有针对性地使用抗菌药物，并降低广谱抗生素不必要使用的频率/时长。
