Department of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
Advanced Regional Research Center in Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy, 30041 Timisoara, Romania.
Medicina (Kaunas). 2023 Apr 6;59(4):721. doi: 10.3390/medicina59040721.
: Acute cholangitis (AC) is still lethal if not treated promptly and effectively. Biliary drainage, also known as source control, has been acknowledged as the backbone treatment for patients with AC; nonetheless, antimicrobial therapy allows these patients to undergo non-emergent drainage procedures. This retrospective study aims to observe the bacterial species involved in AC and analyze the antimicrobial resistance patterns. : Data were collected for four years, comparing patients with benign and malignant bile duct obstruction as an etiology for AC. A total of 262 patients were included in the study, with 124 cases of malignant obstruction and 138 cases of benign obstruction. : Positive bile culture was obtained in 192 (73.3%) patients with AC, with a higher rate among the benign group compared with malignant etiologies (55.7%.vs 44.3%). There was no significant difference between the Tokyo severity scores in the two study groups, identifying 34.7% cases of malignant obstruction with Tokyo Grade 1 (TG1) and 43.5% cases of TG1 among patients with benign obstruction. Similarly, there were no significant differences between the number of bacteria types identified in bile, most of them being monobacterial infections (19% in the TG1 group, 17% in the TG2 group, and 10% in the TG3 group). The most commonly identified microorganism in blood and bile cultures among both study groups was (46.7%), followed by spp. (36.0%) and spp. (8.0%). Regarding antimicrobial resistance, it was observed that significantly more patients with malignant bile duct obstruction had a higher percentage of bacterial resistance for cefepime (33.3% vs. 11.7%, -value = 0.0003), ceftazidime (36.5% vs. 14.5%, -value = 0.0006), meropenem (15.4% vs. 3.6%, -value = 0.0047), and imipenem (20.2% vs. 2.6%, -value < 0.0001). : The positive rate of biliary cultures is higher among patients with benign biliary obstruction, while the malignant etiology correlates with increased resistance to cefepime, ceftazidime, meropenem, and imipenem.
急性胆管炎（AC）如果不能及时、有效地治疗，仍会致命。胆道引流，也称为源头控制，已被公认为 AC 患者的基本治疗方法；尽管如此，抗菌治疗可以使这些患者接受非紧急引流手术。本回顾性研究旨在观察 AC 涉及的细菌种类，并分析抗菌药物耐药模式。
数据收集了四年，比较了良性和恶性胆管梗阻作为 AC 病因的患者。共有 262 名患者纳入研究，其中恶性梗阻 124 例，良性梗阻 138 例。
AC 患者胆汁培养阳性 192 例（73.3%），良性组阳性率高于恶性病因组（55.7%比 44.3%）。两组东京严重程度评分无显著差异，恶性梗阻中东京分级 1 级（TG1）占 34.7%，良性梗阻中 TG1 占 43.5%。同样，胆汁中鉴定的细菌类型数量也无显著差异，多数为单菌感染（TG1 组 19%，TG2 组 17%，TG3 组 10%）。两组患者血、胆汁培养中最常见的微生物是 （46.7%），其次是 spp.（36.0%）和 spp.（8.0%）。关于抗菌药物耐药性，观察到恶性胆管梗阻患者头孢吡肟（33.3%比 11.7%，-值=0.0003）、头孢他啶（36.5%比 14.5%，-值=0.0006）、美罗培南（15.4%比 3.6%，-值=0.0047）和亚胺培南（20.2%比 2.6%，-值<0.0001）的细菌耐药率显著更高。
胆汁培养阳性率在良性胆管梗阻患者中较高，而恶性病因与头孢吡肟、头孢他啶、美罗培南和亚胺培南耐药率增加相关。
