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Chen S, Lai W, Song X, Lu J, Liang J, Ouyang H, Zheng W, Chen J, Yin Z, Li H, Zhou Y. The distribution and antibiotic-resistant characteristics and risk factors of pathogens associated with clinical biliary tract infection in humans. Front Microbiol 2024; 15:1404366. [PMID: 38784792 PMCID: PMC11112516 DOI: 10.3389/fmicb.2024.1404366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Biliary Infection in patients is a common and important phenomenon resulting in severe complications and high morbidity, while the distributions and drug resistance profiles of biliary bacteria and related risk factors are dynamic. This study explored the characteristics of and risk factors for biliary infection to promote the rational use of antibiotics in clinically. Methods Bacterial identification and drug susceptibility testing were completed using the Vitek 2 Compact analysis system. The distribution and antibiotic-resistant characteristics of 3,490 strains of biliary bacteria in patients at Nankai Hospital from 2019 to 2021 were analyzed using Whonet 5.6 and SPSS 26.0 software. We then retrospectively analyzed the clinical data and risk factors associated with 2,340 strains of Gram-negative bacilli, which were divided into multidrug-resistant bacteria (1,508 cases) and non-multidrug-resistant bacteria (832 cases) by a multivariate Cox regression model. Results and discussion A total of 3,490 pathogenic bacterial strains were isolated from bile samples, including 2,340 (67.05%) Gram-negative strains, 1,029 (29.48%) Gram-positive strains, and 109 (4.56%) fungal strains. The top five pathogenic bacteria were Escherichia coli, Klebsiella pneumoniae, Enterococcus faecium, Enterococcus faecalis, and Pseudomonas aeruginosa. The rate of Escherichia coli resistance to ciprofloxacin increased (p < 0.05), while the resistance to amikacin decreased (p < 0.05). The resistance of Klebsiella pneumoniae to cephalosporins, carbapenems, β-lactamase inhibitors, cephalases, aminoglycosides, and quinolones increased (p < 0.05), and the resistance of Pseudomonas aeruginosa to piperacillin, piperacillin/tazobactam, ticacillin/clavulanic acid, and amicacin declined significantly (p < 0.05). The resistance of Enterococcus faecium to tetracycline increased by year (p < 0.05), and the resistance of Enterococcus faecalis to erythromycin and high-concentration gentamicin declined (p < 0.05). Multivariate logistic regression analysis suggested that the administration of third- or fourth-generation cephalosporins was an independent risk factor for biliary infection. In summary, Gram-negative bacilli were the most common pathogenic bacteria isolated from biliary infection patients, especially Escherichia coli, and the rates and patterns of drug resistance were high and in constant flux; therefore, rational antimicrobial drug use should be carried out considering risk factors.
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Affiliation(s)
- Shayan Chen
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
- Central Laboratory, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Precision Medicine, Guangdong, China
| | - Wenbin Lai
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
| | - Xuejing Song
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
- Central Laboratory, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Precision Medicine, Guangdong, China
| | - Jiongtang Lu
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
| | - Jianxin Liang
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
| | - Hao Ouyang
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
| | - Weihua Zheng
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
| | - Jianjun Chen
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
| | - Zhenggang Yin
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
| | - Huimin Li
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
| | - Yong Zhou
- Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China
- Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China
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Mukai Y, Asukai K, Akita H, Kubo M, Hasegawa S, Wada H, Miyata H, Ohue M, Sakon M, Takahashi H. Assessing Intra-abdominal status for clinically relevant postoperative pancreatic fistula based on postoperative fluid collection and drain amylase levels after distal pancreatectomy. Ann Gastroenterol Surg 2024; 8:321-331. [PMID: 38455495 PMCID: PMC10914692 DOI: 10.1002/ags3.12741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/26/2023] [Accepted: 09/05/2023] [Indexed: 03/09/2024] Open
Abstract
Aim The aim of this study was to evaluate the intra-abdominal status related to postoperative pancreatic fistula by combining postoperative fluid collection and drain amylase levels. Methods We retrospectively reviewed the data of 203 patients who underwent distal pancreatectomy and classified their postoperative abdominal status into four groups based on postoperative fluid collection size and drain amylase levels. We also evaluated the incidence of clinically relevant postoperative pancreatic fistula in each group according to C-reactive protein values. Results The incidence of clinically relevant postoperative pancreatic fistula in the entire cohort (n = 203) was 28.1%. Multivariate analysis revealed that postoperative fluid collection, drain amylase levels, and C-reactive protein levels are considerable risk factors for clinically relevant postoperative pancreatic fistula. In the subgroup with large postoperative fluid collection and high drain amylase levels, 65.9% of patients developed clinically relevant postoperative pancreatic fistula. However, no significant difference was observed in C-reactive protein levels between patients with clinically relevant postoperative pancreatic fistula and those without it. In contrast, in the subgroup with a large postoperative fluid collection size or a high amylase level alone, a significant difference was observed in C-reactive protein values between the patients with clinically relevant postoperative pancreatic fistula and those without it. Conclusion Postoperative fluid collection status and the C-reactive protein value provide a more precise assessment of intra=abdominal status related to postoperative pancreatic fistula after distal pancreatectomy. This detailed analysis may be a clinically reasonable approach to individual drain management.
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Affiliation(s)
- Yosuke Mukai
- Department of SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Kei Asukai
- Department of SurgeryYao Municipal HospitalOsakaJapan
| | - Hirofumi Akita
- Department of SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Masahiko Kubo
- Department of SurgeryOsaka International Cancer InstituteOsakaJapan
| | | | - Hiroshi Wada
- Department of SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Hiroshi Miyata
- Department of SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Masayuki Ohue
- Department of SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Masato Sakon
- Department of SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Hidenori Takahashi
- Department of SurgeryOsaka International Cancer InstituteOsakaJapan
- Department of Gastroenterological Surgery, Graduate School of MedicineOsaka UniversityOsakaJapan
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Tarvainen T, Bonsdorff A, Kolho E, Sirén J, Kokkola A, Sallinen V. Association of cephalosporin resistance in intraoperative biliary cultures with surgical site infections in patients undergoing pancreaticoduodenectomy. A retrospective cohort study. HPB (Oxford) 2024; 26:259-269. [PMID: 37891151 DOI: 10.1016/j.hpb.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The aim of this study was to assess the incidence of bacterobilia at the time of a pancreaticoduodenectomy (PD) and the association of resistant bacteria in bile to surgical site infections (SSI). METHODS This was a retrospective cohort study including patients undergoing PD in a single center between May 2016 and October 2020. Data of preoperative biliary drainage (PBD), intraoperative biliary cultures (IBC) and postoperative complications were analysed to assess the risk factors for resistant bacteria in IBC and SSIs. RESULTS Of 361 patients included, 254 (70%) had undergone PBD. Second-generation cephalosporin resistant bacteria were found in IBC of 183 (64%) of all the patients. PBD was the only risk factor for second-generation cephalosporin resistance. The risk for second-generation cephalosporin resistance was more than 20-fold in patients with PBD [n = 170/254 (67%) (OR 22.58 (95% CI, 9.61-53.01), p < 0.001)] compared to patients who did not have PBD (n = 13/107 (12%)). Also, if the time between PBD and surgery was 2 months or more the second-generation cephalosporin resistance in IBC increased the risk for SSIs (OR 4.14 (95% CI, 1.18-14.51), p = 0.027). CONCLUSION The second-generation cephalosporin resistance in IBC is common in patients who have undergone PBD. Broad-spectrum antibiotics in prophylaxis may be beneficial for these patients.
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Affiliation(s)
- Timo Tarvainen
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Akseli Bonsdorff
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Elina Kolho
- Department of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jukka Sirén
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Arto Kokkola
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ville Sallinen
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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