Analysis of characteristics of bile cultures and types of bililary infections_West China Medical Journal

Authors：

YU Xinyan ^1,2 , CHEN Wensen ² , ZHANG Xiang ² , ZHANG Yongxiang ² , LI Songqin ² , ZHANG Weihong ² , ZHAO Ru ¹ ,  LIU Bo ²

1. Department of Infection Control, Jiangyin Hospital Affiliated to Medical School of Southeast University, Jiangyin, Jiangsu 214400, P. R. China;
2. Office of Infection Management, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P. R. China;

Corresponding?author：

LIU Bo, Email: liusanbo@163.com

Keywords：

Bile culture; Biliary duct infection; Biliary duct colonization; Blood culture; Antibiotics use

DOI：

10.7507/1002-0179.201801095

Video：

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Objective To explore the pathogen distribution and the characteristics of antibiotics use of patients with positive bile culture in order to provide evidence for appropriate antibiotic use. Methods Using a patient-based approach, the clinical and laboratory data of patients with positive bile culture between December 1st 2016 and November 30th 2017 were retrospectively analyzed. The pathogen distribution and antibiotics use of patients with bililary duct infections and colonizations were analyzed. Multidrug-resistant organism infections of patients with bililary duct infections were studied. Results There were 299 submitted bililary samples and in which 158 were culture-positive (52.8%). One hundred and ten strains of pathogens were found in 79 patients with positive bile culture, including 66 strains of Gram-negative (G^–) organisms (60.0%), 37 strains of Gram-positive (G⁺) organisms (33.6%), and 7 strains of fungi (6.4%). The top three G^– organisms were Escherichia coli (25 strains, 22.7%), Klebsiella pneumoniae (9 strains, 8.2%), and Acinetobacter baumanii (7 strains, 6.4%). The top three G⁺ organisms were Enterococcus faecium (10 strains, 9.1%), Enterococcus faecalis (6 strains, 5.5%), and coagulase negativeStaphylococcus (6 strains, 5.5%). The number of patients with bililary duct infections and colonizations were 42 and 37, respectively, with pathogens occupied mainly by G^– bacteria. Ten strains of multidrug-resistant organisms were isolated from patients with bililary duct infections. Compared to patients with non-multidrug-resistant organism infections, the length of antibiotics use was longer in patients with multidrug- resistant organism infections (t=2.129, P=0.039). The rate of target therapy for antibiotics in patients with bililary duct infections was 76.2%. The rate of proper antibiotics use was 16.2% before positive bile culture and 78.4% after positive bile culture in patients with bililary duct colonizations. Conclusions Pathogens isolated from bile culture of infection and colonization are predominantly G^– organisms. The bile culture and blood culture should be done for patients with suspected bililary duct infection. Infection and colonization should be distinguished for positive bile culture and antibiotic should be chosen according to drug susceptibility test results.

Citation： YU Xinyan, CHEN Wensen, ZHANG Xiang, ZHANG Yongxiang, LI Songqin, ZHANG Weihong, ZHAO Ru, LIU Bo. Analysis of characteristics of bile cultures and types of bililary infections. West China Medical Journal, 2018, 33(3): 284-288. doi: 10.7507/1002-0179.201801095 Copy

1.	黃潔, 李瑪琳, 孫敏, 等. 梗阻性黃疸患者膽汁微生物群落限制性片段多態性分析. 中華實驗外科雜志, 2014, 31(11): 2396-2398.
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5.	中華醫學會外科學分會膽道外科學組. 急性膽道系統感染的診斷和治療指南 (2011 版).中華消化外科雜志, 2011, 10(1): 9-13.
6.	Park JW, Lee JK, Lee KT, et al. How to interpret the bile culture results of patients with biliary tract infections. Clin Res Hepatol Gastroenterol, 2014, 38(3): 300-309.
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9.	王秋霞. 膽道感染人群膽汁中細菌最新分布情況及對抗菌素敏感性的變化分析. 河北醫藥, 2017, 39(6): 945-946.
10.	王志剛, 潘樂玉, 徐金蓮, 等. 膽道感染致病菌分布及耐藥性的研究. 中華實驗外科雜志, 2015, 32(8): 1973-1975.
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12.	周春妹, 胡必杰, 呂媛. 衛生部全國細菌耐藥監測網 2011 年膽汁培養病原菌耐藥監測. 中國臨床藥理學雜志, 2012, 28(12): 933-936.
13.	呂驊, 朱明煒, 牛小娟, 等. 外科膽道感染病原菌單中心 30 年變遷. 中華肝膽外科雜志, 2016, 22(9): 611-613.
14.	李儒, 劉波, 張衛紅, 等. 2013-2015 年微生物培養中無菌標本送檢情況分析. 南京醫科大學學報: 自然科學版, 2017, 37(3): 332-334.
15.	Weber A, Huber W, kamereck K, et al. In vitro activity of moxifloxacin and piperacillin/ sulbactam against pathogens of acute cholangitis. World J Gastroenterol, 2008, 14(20): 3174-3178.
16.	Kochar R, Banerjee S. Infections of the biliary tract. Gastrointest Endosc Clin N Am, 2013, 23(2): 199-218.
17.	Yu H, Guo Z, Xing W, et al. Bile culture and susceptibility testing of malignant biliary obstruction via PTBD. Cardiovasc Intervent Radiol, 2012, 35(5): 1136-1144.
18.	鄒雪飛, 吳廣利, 王偉, 等. 膽石癥合并急性膽管炎患者膽汁及血液病原菌培養及藥敏分析. 中華實驗和臨床感染病雜志: 電子版, 2015, 9(1): 91-95.
19.	Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control, 2008, 36(5): 309-332.
20.	Weinstein MP, Doern GV. A critical appraisal of the role of the clinical microbiology laboratory in the diagnosis of bloodstream infections. J Clin Microbiol, 2011, 49(9 Suppl): S26-S29.
21.	《抗菌藥物臨床應用指導原則》修訂工作組. 抗菌藥物臨床應用指導原則 (2015 年版). 北京: 人民衛生出版社, 2015.

1. 黃潔, 李瑪琳, 孫敏, 等. 梗阻性黃疸患者膽汁微生物群落限制性片段多態性分析. 中華實驗外科雜志, 2014, 31(11): 2396-2398.
2. Yokoe M, Hata J, Takada T, et al. Tokyo guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci, 2018, 25(1): 41-54.
3. 高戈, 馮喆. 外科膿毒癥及膿毒性休克現狀與展望. 中華實驗外科雜志, 2015, 32(2): 232-234.
4. Lüebbert C, Wendt K, Feisthammel J, et al. Epidemiology and resistance patterns of bacterial and fungal colonization of biliary plastic stents: a prospective cohort study. PLoS One, 2016, 11(5): e0155479.
5. 中華醫學會外科學分會膽道外科學組. 急性膽道系統感染的診斷和治療指南 (2011 版).中華消化外科雜志, 2011, 10(1): 9-13.
6. Park JW, Lee JK, Lee KT, et al. How to interpret the bile culture results of patients with biliary tract infections. Clin Res Hepatol Gastroenterol, 2014, 38(3): 300-309.
7. 黃勛, 鄧子德, 倪語星, 等. 多重耐藥菌醫院感染預防與控制中國專家共識. 中國感染控制雜志, 2015, 14(1): 1-9.
8. Bornscheuer T, Schmiedel S. Calculated antibiosis of acute cholangitis and cholecystitis. Viszeralmedizin. 2014, 30(5): 297-302.
9. 王秋霞. 膽道感染人群膽汁中細菌最新分布情況及對抗菌素敏感性的變化分析. 河北醫藥, 2017, 39(6): 945-946.
10. 王志剛, 潘樂玉, 徐金蓮, 等. 膽道感染致病菌分布及耐藥性的研究. 中華實驗外科雜志, 2015, 32(8): 1973-1975.
11. 孫志, 王鵬遠, 李威, 等. 2012 年全國三級醫院膽汁培養病原菌的構成及耐藥性分析. 中國臨床藥理學雜志, 2015, 31(11): 1038-1041.
12. 周春妹, 胡必杰, 呂媛. 衛生部全國細菌耐藥監測網 2011 年膽汁培養病原菌耐藥監測. 中國臨床藥理學雜志, 2012, 28(12): 933-936.
13. 呂驊, 朱明煒, 牛小娟, 等. 外科膽道感染病原菌單中心 30 年變遷. 中華肝膽外科雜志, 2016, 22(9): 611-613.
14. 李儒, 劉波, 張衛紅, 等. 2013-2015 年微生物培養中無菌標本送檢情況分析. 南京醫科大學學報: 自然科學版, 2017, 37(3): 332-334.
15. Weber A, Huber W, kamereck K, et al. In vitro activity of moxifloxacin and piperacillin/ sulbactam against pathogens of acute cholangitis. World J Gastroenterol, 2008, 14(20): 3174-3178.
16. Kochar R, Banerjee S. Infections of the biliary tract. Gastrointest Endosc Clin N Am, 2013, 23(2): 199-218.
17. Yu H, Guo Z, Xing W, et al. Bile culture and susceptibility testing of malignant biliary obstruction via PTBD. Cardiovasc Intervent Radiol, 2012, 35(5): 1136-1144.
18. 鄒雪飛, 吳廣利, 王偉, 等. 膽石癥合并急性膽管炎患者膽汁及血液病原菌培養及藥敏分析. 中華實驗和臨床感染病雜志: 電子版, 2015, 9(1): 91-95.
19. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control, 2008, 36(5): 309-332.
20. Weinstein MP, Doern GV. A critical appraisal of the role of the clinical microbiology laboratory in the diagnosis of bloodstream infections. J Clin Microbiol, 2011, 49(9 Suppl): S26-S29.
21. 《抗菌藥物臨床應用指導原則》修訂工作組. 抗菌藥物臨床應用指導原則 (2015 年版). 北京: 人民衛生出版社, 2015.

West China Medical Journal

Analysis of characteristics of bile cultures and types of bililary infections

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