胆道相关血流感染的流行病学和经验性治疗的充分性：一项基于澳大利亚人群的研究。

Epidemiology of biliary tract-associated bloodstream infections and adequacy of empiric therapy: an Australian population-based study.

机构信息

Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.

Department of Infectious Diseases, Mater Hospital Brisbane, Brisbane, QLD, Australia.

出版信息

Eur J Clin Microbiol Infect Dis. 2024 Sep;43(9):1753-1760. doi: 10.1007/s10096-024-04894-9. Epub 2024 Jul 10.

DOI:10.1007/s10096-024-04894-9

PMID:38985222

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11349862/

Abstract

PURPOSE

Although the biliary tract is a common source of invasive infections, the epidemiology of cholangitis- and cholecystitis-associated bloodstream infection (BSI) is not well defined. The objective of this study was to determine the incidence, clinical determinants, microbiology of biliary tract-associated BSI, and predicted adequacy of common empiric therapy regimens.

METHODS

All biliary tract-associated BSI in Queensland during 2000-2019 were identified using state-wide data sources. Predicted adequacy of empiric antimicrobial therapy was determined according to microbiological susceptibility data.

RESULTS

There were 3,698 episodes of biliary tract-associated BSI occurred in 3,433 patients of which 2,147 (58.1%) episodes were due to cholangitis and 1,551 (41.9%) cholecystitis, for age- and sex-standardized incidence rates of 2.7, and 2.0 per 100,000 population, respectively. An increasing incidence of biliary tract-associated BSI was observed over the study that was attributable to an increase in cholangitis cases. There was a significant increased risk for biliary tract-associated BSI observed with advancing age and male sex. Patients with cholangitis were older, more likely to have healthcare associated infection, and have more comorbidities most notably liver disease and malignancies as compared to patients with cholecystitis. The distribution of infecting pathogens was significantly different with polymicrobial aetiologies more commonly observed with cholangitis (18.4% vs. 10.5%; p < 0.001). The combination of ampicillin/gentamicin/metronidazole was predicted to have the overall highest adequacy (96.1%), whereas amoxicillin/clavulanate had the lowest (77.0%). Amoxicillin/clavulanate (75.2% vs. 79.4%, p:0.03) and ceftriaxone/metronidazole (83.4% vs. 89.6%; p < 0.001) showed significantly inferior predicted adequacy for cholangitis as compared to cholecystitis.

CONCLUSIONS

Bloodstream infections related to cholecystitis and cholangitis exhibit different epidemiology, microbiology, and requirements for empiric therapy.

摘要

目的

尽管胆道是侵袭性感染的常见来源，但胆管炎和胆囊炎相关血流感染（BSI）的流行病学仍未得到很好的定义。本研究的目的是确定胆道相关 BSI 的发病率、临床决定因素、微生物学特征以及常见经验性治疗方案的预测充分性。

方法

使用全州范围的数据来源确定 2000 年至 2019 年期间昆士兰州所有胆道相关 BSI。根据微生物学敏感性数据确定经验性抗菌治疗的预测充分性。

结果

3433 名患者中有 3698 例胆道相关 BSI，其中 2147 例（58.1%）由胆管炎引起，1551 例（41.9%）由胆囊炎引起，年龄和性别标准化发病率分别为每 100,000 人口 2.7 和 2.0。研究期间，胆道相关 BSI 的发病率呈上升趋势，这归因于胆管炎病例的增加。年龄增长和男性性别与胆道相关 BSI 的风险增加显著相关。胆管炎患者年龄较大，更有可能患有与医疗保健相关的感染，并且合并症更多，尤其是肝病和恶性肿瘤，与胆囊炎患者相比。感染病原体的分布明显不同，胆管炎更常见混合感染（18.4%比 10.5%；p<0.001）。氨苄西林/庆大霉素/甲硝唑联合用药被预测总体上具有最高的充分性（96.1%），而阿莫西林/克拉维酸的充分性最低（77.0%）。与胆囊炎相比，阿莫西林/克拉维酸（75.2%比 79.4%，p：0.03）和头孢曲松/甲硝唑（83.4%比 89.6%；p<0.001）的预测充分性明显较差。