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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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Kar M, Dubey A, Patel SS, Sahu C, Yadav A. Multifactorial Analysis of Biliary Infection in Patients with Hepato-pancreatico-biliary and Associated Intraabdominal Malignancies Admitted to a Teaching Hospital in Northern India. Euroasian J Hepatogastroenterol 2023; 13:10-17. [PMID: 37554979 PMCID: PMC10405806 DOI: 10.5005/jp-journals-10018-1389] [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: 03/18/2023] [Accepted: 06/23/2023] [Indexed: 08/10/2023] Open
Abstract
Background Blockage of the biliary tract is commonly caused by malignant tumors leading to deranged liver function, responsible for poor prognosis and a high rate of bacteriobilia leading to mortality. Material and methods We collected retrospective data from the hospital information system and laboratory registers in our department from 2021 to 2022 to evaluate biliary infections in patients with hepato-pancreatico-biliary and associated intraabdominal malignancies. Result A total of 118 (118/234, 50.43%) patients' bile samples were estimated in this study. Patients' average age was 53.02 ± 13.49 years, with more patients below the age of 65 years among those with infected bile samples. Eight patients were infected by 102 pathogenic microorganisms. The most common pathogenic microorganism responsible for biliary infection in patients with abdominal malignancies was Escherichia coli (38/102, 37.25%) followed by Klebsiella pneumoniae (21/102, 20.59%) and Enterococcus spp. (18/102, 17.65%). Underlying comorbidities like diabetes mellitus, hypothyroidism, hypoproteinemia, chronic liver disease, immunosuppression, chronic kidney disease, increased hospital stay, admission to the intensive care unit (ICU), and presence of percutaneous transhepatic biliary drain were statistically significant risk factors for isolation of multidrug-resistant pathogenic bacteria. Conclusion Our study guided physicians in identifying the associated demographic characteristics, risk factors, and the spectrum of pathogens responsible for bacteriobilia in abdominal cancer patients along with the antibiotic resistance pattern among these isolates and better selection of antibiotics and antibiotic prophylaxis for patients at risk of developing biliary tract infections with multidrug-resistant pathogens. How to cite this article Kar M, Dubey A, Patel SS, et al. Multifactorial Analysis of Biliary Infection in Patients with Hepato-pancreatico-biliary and Associated Intraabdominal Malignancies Admitted to a Teaching Hospital in Northern India. Euroasian J Hepato-Gastroenterol 2023;13(1):10-17.
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Affiliation(s)
- Mitra Kar
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Akanksha Dubey
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sangram Singh Patel
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Chinmoy Sahu
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anjali Yadav
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Infections in Pediatric Living Donor Transplantation in Undernourished Patients in a Developing Country: Aspects to Consider. Pediatr Crit Care Med 2019; 20:1103. [PMID: 31688686 DOI: 10.1097/pcc.0000000000002085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Haag GM, Herrmann T, Jaeger D, Stremmel W, Schemmer P, Sauer P, Gotthardt DN. Outcomes and risk factors for cancer patients undergoing endoscopic intervention of malignant biliary obstruction. BMC Gastroenterol 2015; 15:171. [PMID: 26637394 PMCID: PMC4670509 DOI: 10.1186/s12876-015-0399-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/25/2015] [Indexed: 12/29/2022] Open
Abstract
Background Malignant bile duct obstruction is a common problem among cancer patients with hepatic or lymphatic metastases. Endoscopic retrograde cholangiography (ERC) with the placement of a stent is the method of choice to improve biliary flow. Only little data exist concerning the outcome of patients with malignant biliary obstruction in relationship to microbial isolates from bile. Methods Bile samples were taken during the ERC procedure in tumor patients with biliary obstruction. Clinical data including laboratory values, tumor-specific treatment and outcome data were prospectively collected. Results 206 ERC interventions in 163 patients were recorded. In 43 % of the patients, systemic treatment was (re-) initiated after successful biliary drainage. A variety of bacteria and fungi was detected in the bile samples. One-year survival was significantly worse in patients from whom multiresistant pathogens were isolated than in patients, in whom other species were detected. Increased levels of inflammatory markers were associated with a poor one-year survival. The negative impact of these two factors was confirmed in multivariate analysis. In patients with pancreatic cancer, univariate analysis showed a negative impact on one-year survival in case of detection of Candida species in the bile. Multivariate analysis confirmed the negative prognostic impact of Candida in the bile in pancreatic cancer patients. Conclusion Outcome in tumor patients with malignant bile obstruction is associated with the type of microbial biliary colonization. The proof of multiresistant pathogens or Candida, as well as the level of inflammation markers, have an impact on the prognosis of the underlying tumor disease.
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Affiliation(s)
- Georg-Martin Haag
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany.
| | - Thomas Herrmann
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany. .,Department of Gastroenterology, Toxicology and Infectious Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany. .,Department of Internal Medicine I, Gastroenterology, Hematology and Medical Oncology, Hospital Heide, Heide, 25746, Germany.
| | - Dirk Jaeger
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany. .,Liver Cancer Center Heidelberg (LCCH), University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany.
| | - Wolfgang Stremmel
- Department of Gastroenterology, Toxicology and Infectious Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany. .,Liver Cancer Center Heidelberg (LCCH), University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany.
| | - Peter Schemmer
- Department of Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany. .,Liver Cancer Center Heidelberg (LCCH), University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany.
| | - Peter Sauer
- Department of Gastroenterology, Toxicology and Infectious Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.
| | - Daniel Nils Gotthardt
- Department of Gastroenterology, Toxicology and Infectious Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany. .,Liver Cancer Center Heidelberg (LCCH), University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany.
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Sganga G, Bianco G, Fiori B, Nure E, Spanu T, Lirosi MC, Frongillo F, Agnes S. Surveillance of bacterial and fungal infections in the postoperative period following liver transplantation: a series from 2005-2011. Transplant Proc 2014; 45:2718-21. [PMID: 24034031 DOI: 10.1016/j.transproceed.2013.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Orthotopic liver transplantation (OLT) is a life-saving procedure for the treatment of many end-stage diseases, but infectious and acute rejection episodes remain major causes of morbidity and mortality. Bacterial and fungal infections can be due to intra-abdominal, biliary, respiratory, urinary, wound, central venous catheters (CVC) or unknown sources. Using the computerized database of our microbiology laboratory, we analyzed all the bacterial and fungal infections in the first three months following OLT among 151 consecutive adult recipients at single center between January 2005 and December 2011. Samples included blood, bile CVC, urine, and bronchoalveolar lavage (BAL) specimen. Culture and identification of the isolated microorganisms was done in accordance with standard microbiological procedures. Three hundred thirteen samples from the above sites showed positive results for gram-positive cocci (n = 137; 43.8%), gram-negative rods (n = 156; 49.8%), and Candida species (n = 19; 6.1%). One patient (0.3%) experienced a CVC-related infection caused by Fusarium oxysporum. Bacterial and particularly biliary tract infections seem to play major roles in morbidity and mortality in the first three months following OLT. The major contributors to patient morbidity and mortality were candidemia and/or invasive candidiasis mainly from the biliary tract and/or CVC-related infections.
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Affiliation(s)
- G Sganga
- Department of Surgery, Division of General Surgery and Organ Transplantation, Catholic University of the Sacred Heart, Rome, Italy.
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Schukfeh N, Doerner JM, Heintschel von Heinegg E, Steinmann J, Metzelder ML, Kathemann S, Hoyer PF, Paul A, Gerner P. Spectrum of pathogens in native liver, bile, and blood during pediatric liver transplantation. Pediatr Transplant 2014; 18:266-71. [PMID: 24597705 DOI: 10.1111/petr.12237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2014] [Indexed: 11/29/2022]
Abstract
During LTX, there may be a risk that pathogens of the native liver are released into the systemic circulation. No investigations on incidence/spectrum of pathogens in native livers have been published. We hypothesized that pathogens are found in the native liver of a large proportion of pediatric patients during LTX and investigated the microbiology of native livers. These data may help optimize antibiotic therapy. Twenty-two consecutive pediatric patients (median age 14 months, range, 5 months-15 yr) receiving LTX in our department from October 2010 to October 2011 were included in this prospective study. Tissue and bile were collected from the explanted liver and were cultivated on different media. All liver tissues were investigated using a broad-range PCR (SepsiTest(®)). In 16 patients, blood cultures were collected post-transplantation. Eleven patients (50%) had at least one pathogen detected; nine of these patients had an underlying diagnosis of biliary atresia. SepsiTest(®) was positive in seven patients. In four patients it was the only test detecting any pathogen. In detail, the positivity rate for liver tissue in all patients was 41% (n = 9); for bile 25% (n = 3); and for blood 25% (n = 4). Thirteen different pathogens (69% bacterial, 31% fungal) were isolated. A highly-sensitive broad-range PCR appears to be an effective method to detect pathogens in native livers of patients undergoing LTX. A high number and variety of microbes, including a high proportion of fungal pathogens, were detected.
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Affiliation(s)
- Nagoud Schukfeh
- Division of Paediatric Surgery, Department of General-Visceral and Transplant Surgery, University Hospital, University Duisburg-Essen, Essen, Germany
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Kettelhut VV, Van Schooneveld T. Quality of surgical care in liver and small-bowel transplant: approach to risk assessment and antibiotic prophylaxis. Prog Transplant 2011. [PMID: 21265284 DOI: 10.7182/prtr.20.4.n2t8t9766110q647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In August 2002, The Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention implemented the National Surgical Infection Prevention project. The goal of the project was to decrease the morbidity and mortality associated with postoperative surgical site infections through appropriate selection and timing of administration and discontinuation of prophylactic antimicrobials. The National Surgical Infection Prevention project, however, excluded transplant surgeries from its focus because of the lack of randomized clinical trials comparing antimicrobial agents. The goals of this article are to (1) provide a framework for risk factors associated with surgical site infections in liver, small-bowel, and multivisceral transplants; (2) review general principles of the appropriate antimicrobial prophylaxis; (3) provide a framework for developing a triage of liver, small-bowel, and multivisceral transplant candidates for appropriate antibiotic prophylaxis; and (4) develop an approach to further quality improvements in transplant surgical care. A multidisciplinary team produced recommendations for antibacterial prophylaxis and monitoring.
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Affiliation(s)
- Valeriya V Kettelhut
- Solid Organ Transplant Center, Department of Surgery, University of Nebraska Medical Center, Omaha 68198-7424, USA.
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Kettelhut VV, Van Schooneveld T. Quality of Surgical Care in Liver and Small-Bowel Transplant: Approach to Risk Assessment and Antibiotic Prophylaxis. Prog Transplant 2010; 20:320-8. [DOI: 10.1177/152692481002000404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In August 2002, The Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention implemented the National Surgical Infection Prevention project. The goal of the project was to decrease the morbidity and mortality associated with postoperative surgical site infections through appropriate selection and timing of administration and discontinuation of prophylactic antimicrobials. The National Surgical Infection Prevention project, however, excluded transplant surgeries from its focus because of the lack of randomized clinical trials comparing antimicrobial agents. The goals of this article are to (1) provide a framework for risk factors associated with surgical site infections in liver, small-bowel, and multivisceral transplants; (2) review general principles of the appropriate antimicrobial prophylaxis; (3) provide a framework for developing a triage of liver, small-bowel, and multivisceral transplant candidates for appropriate antibiotic prophylaxis; and (4) develop an approach to further quality improvements in transplant surgical care. A multidisciplinary team produced recommendations for antibacterial prophylaxis and monitoring.
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