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Talha Noor M, Goyal V, Vasepalli P, Jain M, Singh Thakur B, Gorie N. BACTERIAL ISOLATES AND ANTIBIOTIC SENSITIVITY PATTERNS IN CHOLEDOCHAL BILE COLLECTED DURING ERCP: A REPORT FROM CENTRAL INDIA. PARIPEX INDIAN JOURNAL OF RESEARCH 2021:13-15. [DOI: 10.36106/paripex/9606435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Temporal shifts have been known to occur in antibiotic sensitivity patterns of organisms causing cholangitis.The aim of
this prospective study conducted on 100 patients of extra hepatic biliary obstruction (EHBO) was to identify the common
microorganisms cultured from bile obtained during Endoscopic retrograde cholangiography and to study their local
sensitivity pattern.Sixty six patients had growth in bile culture,the maximum growths amongst all micro-organisms were
of Escherichia coli (40.9%) and Pseudomonas aeruginosa (40.9%). Growth rates were significantly higher in patients
with non- malignant causes of biliary obstruction than those with malignant causes. Polymixins had the highest
sensitivity to cultured bacteria followed by aminoglycosides and Imipenem.Study of culture & sensitivity pattern helps
in deciding empirical antibiotic therapy in patients with cholangitis and it should be based on local sensitivity patterns
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Affiliation(s)
- Mohd Talha Noor
- MD, DM, Department of Gastroenterology, Sri Aurobindo Institute of Medical Sciences,Indore (M.P.),India.453555
| | - Vishal Goyal
- Department of Gastroenterology,Sri Aurobindo Institute of Medical Sciences, Indore (M.P.),India.453555
| | - Praveen Vasepalli
- Department of Gastroenterology,Sri Aurobindo Institute of Medical Sciences, Indore (M.P.),India.453555
| | - Mayank Jain
- Department of gastroenterology,Arihant hospital and research centre,Indore, India. 452009
| | - Bhagwan Singh Thakur
- Department of Gastroenterology,Sri Aurobindo Institute of Medical Sciences, Indore (M.P.),India.453555
| | - Nishat Gorie
- Department of Microbiology, Sri Aurobindo Institute of Medical Sciences, Indore (M.P.),India.453555
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Reiter FP, Obermeier W, Jung J, Denk G, Mahajan UM, De Toni EN, Schirra J, Mayerle J, Schulz C. Prevalence, Resistance Rates, and Risk Factors of Pathogens in Routine Bile Cultures Obtained during Endoscopic Retrograde Cholangiography. Dig Dis 2020; 39:42-51. [PMID: 32521535 DOI: 10.1159/000509289] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/09/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION AND OBJECTIVE Acute cholangitis is a life-threatening condition. The early initiation of antibiotic therapy significantly impacts the course of disease. Only few data are available on distribution and resistance profiles of bile pathogens. Here, we report on an analysis of routinely acquired bile specimens and provide an overview of the prevalence, resistance rates, and risk factors for the presence of pathogens in bile. METHODS Bile cultures obtained from 388 endoscopic retrograde cholangiographies (ERCs) with corresponding clinical data were analysed in 208 patients. RESULTS The majority (84.8%) of cultures yielded positive for at least 1 organism. Abundance was highest for Enterococcus faecalis, Enterococcus faecium, and Escherichia coli. Multiresistant organisms were present in 14.9%. The initial antibiotic regimen was changed in 44.1%, which increased the length of hospital stay significantly (***p < 0.001). Pre-existing papillotomy (EPT) or biliary drainage was associated with higher frequency of bile pathogens (**p < 0.01) in a univariate analysis. Multivariate analysis confirmed these results for EPT and revealed significantly more positive results for pathogens, gram-negative bacteria, and fungi in patients with biliary drainage. Significant differences in the prevalence of pathogens were observed between relevant subgroups of ERC indications. The highest susceptibility rates were observed for linezolid and tigecycline in gram-positive bacteria and for meropenem and gentamicin in gram-negative bacteria. CONCLUSIONS Our study provides a comprehensive analysis of the distribution, resistance profiles, and risk factors for the detection of bile pathogens. The frequent change in initial antibiotic treatment highlights the importance of routine bile culture and indicates that current schemas of empirical treatment might not cover the contemporary spectrum of pathogens in bile.
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Affiliation(s)
- Florian P Reiter
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany, .,Liver Center, University Hospital, LMU Munich, Munich, Germany,
| | - Wolfgang Obermeier
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.,Liver Center, University Hospital, LMU Munich, Munich, Germany
| | - Jette Jung
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikobiologie, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Gerald Denk
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.,Liver Center, University Hospital, LMU Munich, Munich, Germany
| | - Ujjwal M Mahajan
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.,Liver Center, University Hospital, LMU Munich, Munich, Germany
| | - Enrico N De Toni
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.,Liver Center, University Hospital, LMU Munich, Munich, Germany
| | - Jörg Schirra
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.,Liver Center, University Hospital, LMU Munich, Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.,Liver Center, University Hospital, LMU Munich, Munich, Germany
| | - Christian Schulz
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.,Liver Center, University Hospital, LMU Munich, Munich, Germany
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Narkhede R, Desai G, Pande P. Bacteriobilia in Hepato-Pancreato-Biliary Surgery: an Enemy or a Friend in Disguise? Indian J Surg 2019. [DOI: 10.1007/s12262-019-01933-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Microbial Profiles and Risk Factors of Preexisting Biliary Infection in Patients with Therapeutic Endoscopy. Gastroenterol Res Pract 2019; 2019:1527328. [PMID: 31191641 PMCID: PMC6525931 DOI: 10.1155/2019/1527328] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/26/2019] [Indexed: 12/16/2022] Open
Abstract
Background The bile infection may already exist before the administration of an interventional procedure, despite no clinical manifestations of cholangitis detected. Blood cultures remained negative even in more than half of the febrile cases with cholangitis. Risk factors associated with bacterial growth in bile before the intervention are not well defined. To establish the bacterial profiles isolated from the bile samples and to identify risk factors for bacterial colonization in the bile system. Methods Individuals who underwent endoscopic retrograde cholangiopancreatography (ERCP) interventions were enrolled. Bile samples were aspirated and were immediately transferred into a sterile tube for storage. Results Positive bile cultures were detected in 363 (38.0%) of 956 patients, including 322 benign diseases and 41 malignances. Of 363 positive cases, 351 (96.7%) were monoinfection and 12 (3.3%) multi-infection. Escherichia coli were the most common Gram-negative bacteria (210, 56.0%), followed by Klebsiella pneumoniae (45, 12.0%). Enterococcus faecalis represented the most common Gram-positive microorganism (19, 5.07%), while Candida albicans (11, 2.93%) were the dominant fungi. Klebsiella pneumoniae were more frequently detected in malignant diseases (P = 0.046). Age, previous ERCP history or OLT history, and CBD diameter were independent risk factors for positive cultures (P < 0.05) while preoperative jaundice drug therapy was the protective factor for bile infection (P < 0.05). Conclusion Monomicrobial infection was dominant among all infections, and Klebsiella pneumoniae strains were more frequently isolated from patients with malignant diseases. To effectively manage patients who are at a high risk for bile infection, a detailed diagnosis and treatment plan for each case should be prepared.
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Cammann S, Timrott K, Vonberg RP, Vondran FWR, Schrem H, Suerbaum S, Klempnauer J, Bektas H, Kleine M. Cholangitis in the postoperative course after biliodigestive anastomosis. Langenbecks Arch Surg 2016; 401:715-24. [PMID: 27236290 DOI: 10.1007/s00423-016-1450-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 05/13/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Hepatobiliary surgery with biliodigestive anastomosis (BDA) results in a loss of the sphincter of Oddi with consecutive ascension of bacteria into the bile system which may cause cholangitis in the postoperative course. METHODS Patients who received reconstruction with a BDA after hepatobiliary surgery were analyzed retrospectively for their postoperative course of disease depending on intraoperatively obtained bile cultures and antibiotic prophylaxis. RESULTS Two hundred forty-three patients were included in the analysis, 49.4 % of whom had received endoscopic stenting before the operation. Stenting was significantly associated with the presence of drug-resistant bacteria in the intraoperatively obtained bile sample (p < 0.001, OR = 4.09). Of all patients, 14.4 % developed postoperative cholangitis. This was significantly associated with the postoperative length of stay in the intensive care unit (p = 0.002, OR = 1.035). The highest incidence of postoperative cholangitis was found in patients with cholangiocellular carcinoma (n = 12, p = 0.046, OR = 2.178). Patients were more likely to harbor strains with resistance against the antibiotic that was given intraoperatively. CONCLUSION The risk for the presence of drug-resistant bacteria is increased by preoperative stenting of the common bile duct. Bile culture by intraoperative swabs can be altered by the perioperative antibiotic prophylaxis as it induces microbiological selection in the common bile duct.
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Affiliation(s)
- Sebastian Cammann
- General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
| | - Kai Timrott
- General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Ralf-Peter Vonberg
- Institute for Medical Microbiology and Hospital Epidemiology, Hanover Medical School, Hanover, Germany
| | - Florian W R Vondran
- General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Harald Schrem
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation, Hanover Medical School, Hanover, Germany
| | - Sebastian Suerbaum
- Institute for Medical Microbiology and Hospital Epidemiology, Hanover Medical School, Hanover, Germany
| | - Jürgen Klempnauer
- General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Hüseyin Bektas
- General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Moritz Kleine
- General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
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Kaya M, Beştaş R, Bacalan F, Bacaksız F, Arslan EG, Kaplan MA. Microbial profile and antibiotic sensitivity pattern in bile cultures from endoscopic retrograde cholangiography patients. World J Gastroenterol 2012; 18:3585-9. [PMID: 22826624 PMCID: PMC3400861 DOI: 10.3748/wjg.v18.i27.3585] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 05/08/2012] [Accepted: 05/26/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify the frequency of bacterial growth, the most commonly grown bacteria and their antibiotic susceptibility, and risk factors for bacterial colonization in bile collected from patients with different biliary diseases.
METHODS: This prospective study was conducted between April 2010 and August 2011. Patients with various biliary disorders were included. Bile was aspirated by placing a single-use, 5F, standard sphincterotome catheter into the bile duct before the injection of contrast agent during endoscopic retrograde cholangiopancreaticography (ERCP). Bile specimens were transported to the microbiology laboratory in blood culture bottles within an anaerobic transport system. Bacteria were cultured and identified according to the standard protocol used in our clinical microbiology laboratory. The susceptibilities of the organisms recovered were identified using antimicrobial disks, chosen according to the initial gram stain of the positive cultures.
RESULTS: Ninety-one patients (27% male, mean age 53.7 ± 17.5 years, range: 17-86 years) were included in the study. The main indication for ERCP was benign biliary disease in 79 patients and malignant disease in 12 patients. The bile culture was positive for bacterial growth in 46 out of 91 (50.5%) patients. The most frequently encountered organisms were Gram-negative bacteria including Escherichia coli (28.2%), Pseudomonas (17.3%) and Stenotrophomonas maltophilia (15.2%). There were no significant differences between patients with malignant and benign disease (58% vs 49%, P = 0.474), patients with acute cholangitis and without acute cholangitis (52.9% vs 50%, P = 0.827), patients who were empirically administered antibiotics before intervention and not administered (51.4% vs 60.7%, P = 0.384), with regard to the bacteriobilia. We observed a large covering spectrum or low resistance to meropenem, amikacin and imipenem.
CONCLUSION: We did not find a significant risk factor for bacteriobilia in patients with biliary obstruction. A bile sample for microbiological analysis may become a valuable diagnostic tool as it leads to more accurate selection of antibiotics for the treatment of cholangitis.
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Sahu MK, Chacko A, Dutta AK, Prakash JAJ. Microbial profile and antibiotic sensitivity pattern in acute bacterial cholangitis. Indian J Gastroenterol 2011; 30:204-8. [PMID: 22006165 DOI: 10.1007/s12664-011-0135-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 09/23/2011] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The changing antimicrobial sensitivity pattern of causative organisms poses a therapeutic challenge in treating patients with acute cholangitis. We therefore evaluated the microbial profile and sensitivity pattern to antibiotics in patients with acute bacterial cholangitis. METHODS Data of patients above 18 years of age with acute bacterial cholangitis seen between January 2004 and March 2007 were retrospectively analyzed. The study was continued prospectively from April 2007 to December 2008. Data on clinical features, etiological and microbial profile and therapy, and patient outcomes were analyzed. In the prospective group, the antibiotic susceptibility patterns of organisms grown on bile and blood culture were also obtained. RESULTS One hundred and eighty-five patients with acute cholangitis were studied. Choledocholithiasis (62.7%) and malignancy (29.2%) were the main predisposing factors. Bile culture was positive in 88 of 95 patients, and blood culture was positive in 47 of 178 (26.4%) patients. Bile cultures were predominantly polymicrobial (69.5%) in contrast to blood cultures (2.2%). E. coli was the predominant isolate in blood and bile. No growth was seen on anaerobic bile or blood cultures. The prospective group showed high resistance of E. coli to third generation cephalosporins and ciprofloxacin. CONCLUSIONS Changing antimicrobial sensitivity patterns requires a revision of empiric antibiotic therapy policy in cholangitis.
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Affiliation(s)
- Manoj Kumar Sahu
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore 632 004, India
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Weber A, Huber W, Kamereck K, Winkle P, Voland P, Weidenbach H, Schmid RM, Prinz C. In vitro activity of moxifloxacin and piperacillin/sulbactam against pathogens of acute cholangitis. World J Gastroenterol 2008; 14:3174-8. [PMID: 18506921 PMCID: PMC2712848 DOI: 10.3748/wjg.14.3174] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the in vitro activity of moxifloxacin and piperacillin/sulbactam against pathogens isolated from patients with acute cholangitis.
METHODS: In this prospective study a total of 65 patients with acute cholangitis due to biliary stone obstruction (n = 7), benign biliary stricture (n = 16), and malignant biliary stricture (n = 42) were investigated with regard to spectrum of bacterial infection and antibiotic resistance. Pathogens were isolated from bile cultures in all study patients. In 22 febrile patients, blood cultures were also obtained. In vitro activity of moxifloxacin and piperacillin/sulbactam was determined by agar diffusion.
RESULTS: Thirty-one out of 65 patients had positive bile and/or blood cultures. In 31 patients, 63 isolates with 17 different species were identified. The predominant strains were Enterococcus species (26/63), E.coli (13/63) and Klebsiella species (8/63). A comparable in vitro activity of moxifloxacin and piperacillin/sulbactam was observed for E.coli and Klebsiella species. In contrast, Enterococcus species had higher resistances towards moxifloxacin. Overall bacteria showed antibiotic resistances in vitro of 34.9% for piperacillin/sulbactam and 36.5% for moxifloxacin.
CONCLUSION: Enterococcus species, E.coli and Klebsiella species were the most common bacteria isolated from bile and/or blood from patients with acute cholangitis. Overall, a mixed infection with several species was observed, and bacteria showed a comparable in vitro activity for piperacillin/sulbactam and moxifloxacin.
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Millonig G, Buratti T, Graziadei IW, Schwaighofer H, Orth D, Margreiter R, Vogel W. Bactobilia after liver transplantation: frequency and antibiotic susceptibility. Liver Transpl 2006; 12:747-53. [PMID: 16628695 DOI: 10.1002/lt.20711] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
After liver transplantation (LT), bactobilia occurs frequently in patients, leading in some cases to cholangitis and biliary sepsis. The present study is the first to investigate bactobilia after LT, and it gives an overview of predisposing factors for bactobilia, the microbial spectrum in the bile of LT patients, and the antibiotic susceptibility. A total of 172 endoscopic retrograde cholangiography (ERC) procedures were performed in 66 LT patients between 1 month and 5.8 years after LT. Bile samples were examined microbiologically. Sixty-eight nontransplanted patients without cholestasis, but requiring ERC for other reasons served as a control group. Of 172 samples obtained from LT patients, 126 (73.3%) were positive for microbes. A total of 236 organisms were isolated: 114 (48.3%) gram-positive bacteria, 92 (39.0%) aerobic gram-negative, 8 (3.4%) anaerobes, and 22 (9.3%) fungi. Ciprofloxacin and amoxycillin/clavulanic acid showed the best susceptibility results among oral antibiotics and piperacillin/tazobactam and imipenem/cilastatin among intravenous preparations. In contrast, only 15.7% of non-LT patients showed bactobilia. In conclusion, our study shows that bactobilia is a problem in patients after LT and that it is not only a contamination from endoscopic intervention. Mechanical obstruction, plastic stents, gallstones, and papillotomy increase the risk of bactobilia significantly. In our cohort we had the best antibiotic susceptibility results for positive cultures in LT patients with piperacillin/tazobactam, ciprofloxacin, or amoxycillin/clavulanic acid.
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Affiliation(s)
- Gunda Millonig
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria.
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