Ansari Zuber, Ray Sukanta, Das Somak, Subhra Mandal Tuhin
Division of Surgical Gastroenterology, Department of General Surgery, FH Medical College and Hospital, Agra, India.
Department of Surgical Gastroenterology, Institute of Postgraduate Medical Education and Research, Kolkata, India.
Turk J Surg. 2024 Jun 28;40(2):154-160. doi: 10.47717/turkjsurg.2024.6364. eCollection 2024 Jun.
Recurrent pyogenic cholangitis (RPC) and ascariasis are prevalent in eastern India. Exact pathogenesis of RPC is still a matter of controversy. Hepatobiliary Ascaris infestation has been considered one of the causative factors in Eastern Asia, but conclusive evidence from India is lacking. RPC is associated with multi-drug-resistant (MDR) bacteria, which is a significant source of morbidity and mortality. This study aimed to assess the role of hepatobiliary ascariasis in pathogenesis of RPC and to study microbial profile and their implications in managing RPC patients.
Consecutive patients with biliary stones who underwent surgery between March 2020 and December 2021 in a tertiary centre in eastern India were divided into RPC and non-RPC groups. Surgically retrieved samples of bile and biliary stones were sent for bacterial culture and microscopic and histopathological examination to identify the evidence of ascariasis in both groups and to study the microbial profile in RPC group.
Eight out of 54 patients (14.8%) in the RPC group had evidence of hepatobiliary ascariasis. None of the patients in non-RPC group showed evidence of ascariasis. was the most common bacterial pathogen on bile culture, and 79% of bacterial isolates were MDR pathogens. Carbapenem group of antibiotics showed the highest sensitivity (66.6%) against bacterial culture growth in RPC patients.
This study showed a higher prevalence of hepatobiliary ascariasis in patients with RPC, but a conclusive etiological role is still lacking. RPC is associated with high incidence of MDR bacteria. Carbapenems may be considered the empirical antibiotic of choice in RPC.
复发性化脓性胆管炎（RPC）和蛔虫病在印度东部普遍存在。RPC的确切发病机制仍存在争议。肝胆蛔虫感染在东亚地区被认为是致病因素之一，但印度缺乏确凿证据。RPC与多重耐药（MDR）细菌有关，这是发病率和死亡率的一个重要来源。本研究旨在评估肝胆蛔虫病在RPC发病机制中的作用，并研究微生物谱及其在RPC患者管理中的意义。
2020年3月至2021年12月期间，在印度东部一家三级中心接受手术的连续胆管结石患者被分为RPC组和非RPC组。手术取出的胆汁和胆管结石样本被送去进行细菌培养以及显微镜和组织病理学检查，以确定两组中蛔虫病的证据，并研究RPC组中的微生物谱。
RPC组54例患者中有8例（14.8%）有肝胆蛔虫病的证据。非RPC组患者均未显示蛔虫病的证据。[此处原文缺失具体细菌名称]是胆汁培养中最常见的细菌病原体，79%的细菌分离株为MDR病原体。碳青霉烯类抗生素对RPC患者细菌培养生长的敏感性最高（66.6%）。
本研究显示RPC患者中肝胆蛔虫病的患病率较高，但仍缺乏确凿的病因学作用。RPC与MDR细菌的高发病率有关。碳青霉烯类药物可被视为RPC经验性抗生素的首选。
