Clinical characteristics associated with hospital infections in patients undergoing endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration for common bile duct stones_West China Medical Journal

Authors：

JIN Suxiang ^1,2 , PENG Xiujuan ² , DAI Rui ² , TIAN Caiyun ² , RUAN Yuhua ² ,  ZANG Feng ¹

1. Department of Infection Management, Jiangsu People’s Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing, Jiangsu 210029, P. R. China;
2. Department of Infection Management, the Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210031, P. R. China;

Corresponding?author：

ZANG Feng, Email: 18652921829@163.com

Keywords：

Endoscopic retrograde cholangiopancreatography; laparoscopic common bile duct exploration; choledocholithiasis; hospital infection; clinical characteristics

DOI：

10.7507/1002-0179.202405246

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Objective To analyze the clinical characteristics associated with hospital infections in patients with common bile duct stones treated by endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE), thereby providing a basis for selecting treatment strategies and formulating hospital infection prevention measures for such patients. Methods Patients with common bile duct stones at Jiangsu Provincial People’s Hospital between January 2020 and July 2023 were retrospectively selected and divided into ERCP and LCBDE groups according to their surgical methods. Basic patient data, length of hospital stay, hospitalization costs, perioperative infection-related indicators, and occurance of hospital infections were compared between groups. Results A total of 402 patients were enrolled, with 242 in the ERCP group and 160 in the LCBDE group. Significant differences were noted in smoking, alcohol consumption, history of lung diseases, history of heart diseases, history of cholecystectomy/biliary surgery, presence of cholecystitis, presence of cholecystolithiasis, number of stones, maximum stone diameter, common bile duct diameter, total hospital stay, and total expenses (P<0.05). Twenty-four hours before surgery, except for the neutrophil count, which was slightly higher in the ERCP group than that in the LCBDE group (P=0.043), the infection-related indicators did not differ significantly between the two groups (P>0.05). Twenty-four hours after surgery, the levels of serum white blood cell, neutrophil, and aspartate aminotransferase in the ERCP group were lower than those in the LCBDE group (P<0.05), and the levels of alkaline phosphatase and gamma-glutamyl transferase in the ERCP group were higher than those in the LCBDE group (P<0.05). A total of 179 bile samples were collected and tested, identifying 137 strains of pathogenic bacteria (78 in the ERCP group and 59 in the LCBDE group). In the ERCP group, 42 strains (53.85%) were Gram-negative bacteria, 34 strains (45.59%) were Gram-positive bacteria, and 2 strains (2.56%) were fungi; in the LCBDE group, 33 strains (55.93%) were Gram-negative bacteria and 26 strains (44.07%) were Gram-positive bacteria. No significant difference was observed in the composition of pathogenic bacteria between the two groups (χ²=1.174, P=0.695). Among the 402 patients, 38 cases of hospital infection occurred postoperatively, with an infection rate of 9.45%. The difference in the infection rate between the ERCP group and the LCBDE group were statistically significant (11.98% vs. 5.63%; χ²=4.550, P=0.033). The main sites of infection were bloodstream, lungs, and abdominal-pelvic cavity. Conclusions The predominant pathogens isolated after both ERCP and LCBDE are Gram-negative bacteria. Compared with LCBDE, ERCP has less impact on inflammatory markers, hospital stay, and costs, but has a higher incidence of hospital infections.

Citation： JIN Suxiang, PENG Xiujuan, DAI Rui, TIAN Caiyun, RUAN Yuhua, ZANG Feng. Clinical characteristics associated with hospital infections in patients undergoing endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration for common bile duct stones. West China Medical Journal, 2025, 40(6): 931-936. doi: 10.7507/1002-0179.202405246 Copy

1.	Ding YB, Deng B, Liu XN, et al. Synchronous vs sequential laparoscopic cholecystectomy for cholecystocholedocholithiasis. World J Gastroenterol, 2013, 19(13): 2080-2086.
2.	Liu B, Wu DS, Cao PK, et al. Percutaneous transhepatic extraction and balloon dilation for simultaneous gallbladder stones and common bile duct stones: a novel technique. World J Gastroenterol, 2018, 24(33): 3799-3805.
3.	Manes G, Paspatis G, Aabakken L, et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy, 2019, 51(5): 472-491.
4.	汪曉紅. 膽囊切除術后膽總管結石的內鏡及腹腔鏡治療并膽總管結石復發的相關因素分析. 南京: 南京醫科大學, 2017.
5.	ASGE Standards of Practice Committee, Buxbaum JL, Abbas Fehmi SM, et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc, 2019, 89(6): 1075-1105.
6.	魯為朋, 孫禮俠, 王晨, 等. ERBD+LCBDE 與 ENBD+ERCP/EST 在膽總管結石合并中重度急性膽管炎中的近期療效對比. 肝膽胰外科雜志, 2023, 35(1): 40-45.
7.	Ricci C, Pagano N, Taffurelli G, et al. Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for management of gallstone disease with biliary duct calculi: a systematic review and network meta-analysis. JAMA Surg, 2018, 153(7): e181167.
8.	陳兵. 腹腔鏡膽總管切開取石一期縫合術 58 例臨床分析. 華西醫學, 2016, 31(9): 1534-1537.
9.	Rendell VR, Pauli EM. Laparoscopic common bile duct exploration. JAMA Surg, 2023, 158(7): 766-767.
10.	顧衛東, 趙璇, 何振洲. 普通外科圍手術期疼痛管理上海專家共識(2020 版). 中國實用外科雜志, 2021, 41(1): 31-37.
11.	中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 2001, 81(5): 61-67.
12.	Satlin MJ, Lewis JS, Weinstein MP, et al. Clinical and laboratory standards institute and european committee on antimicrobial susceptibility testing position statements on polymyxin B and colistin clinical breakpoints. Clin Infect Dis, 2020, 71(9): e523-e529.
13.	中華人民共和國國家衛生健康委員會. 醫院感染監測標準 WS/T 312-2023. 中國感染控制雜志, 2023, 22(9): 1129-1142.
14.	Williams E, Beckingham I, El Sayed G, et al. Updated guideline on the management of common bile duct stones (CBDS). Gut, 2017, 66(5): 765-782.
15.	祝長華. 比較(ERCP+LC)與(LC+LCBDE)兩種術式治療膽囊結石合并膽總管結石療效的 meta 分析. 南昌: 南昌大學, 2023.
16.	賀斌, 張文超, 曾民. 急診 ERCP 治療老年患者膽總管結石繼發急性重癥膽管炎的效果. 中國衛生標準管理, 2023, 14(15): 88-92.
17.	馮其柱, 陳先志, 孫杰, 等. 老年膽總管結石合并急性膽管炎患者 ERCP 術后膽總管結石復發的危險因素分析. 實用醫學雜志, 2023, 39(15): 1945-1949.
18.	樊鵬, 陳治富, 王康. 腹腔鏡膽總管切開取石術后感染情況及危險因素分析. 臨床醫學研究與實踐, 2023, 8(30): 9-12.
19.	丁孟德, 陳中朝, 王林俊, 等. 膽道結石術后醫院感染病原菌及相關影響因素分析. 中華醫院感染學雜志, 2018, 28(1): 84-87.
20.	Yin Y, He K, Xia X. Comparison of primary suture and t-tube drainage after laparoscopic common bile duct exploration combined with intraoperative choledochoscopy in the treatment of secondary common bile duct stones: a single-center retrospective analysis. J Laparoendosc Adv Surg Tech A, 2022, 32(6): 612-619.
21.	Lyu Y, Cheng Y, Li T, et al. Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis. Surg Endosc, 2019, 33(10): 3275-3286.
22.	胡云龍, 宋正偉, 龍昊, 等. 不同膽總管取石術聯合腹腔鏡膽囊切除術治療膽囊結石合并膽總管結石的療效比較. 成都醫學院學報, 2021, 16(1): 46-49.
23.	劉江, 李棟山. 不同膽總管取石術聯合腹腔鏡膽囊切除術治療膽囊結石合并膽總管結石的療效比較. 甘肅科技, 2021, 37(5): 142-145.
24.	馬勇新, 張旭升, 柳科軍, 等. 惡性膽道梗阻 ERCP 術后早期膽道感染預測模型的建立與評價. 中國普通外科雜志, 2023, 32(8): 1208-1217.
25.	伍嬋璐, 姜瑜, 肖燕. 膽管結石合并膽道細菌感染患者膽汁病原菌及其預后影響因素. 中華醫院感染學雜志, 2021, 31(2): 238-243.
26.	劉立彬, 楊連營, 杜慶云, 等. 膽總管結石合并急性膽管炎患者 PTCD 膽汁與血培養病原菌分布及耐藥性分析. 中華醫院感染學雜志, 2019, 29(5): 726-729.
27.	王超智, 侯軒, 王珊, 等. 膽總管結石合并感染患者 ERCP 取石術膽汁中病原菌種類及耐藥性. 熱帶醫學雜志, 2020, 20(5): 683-686.
28.	梁秋明, 黃潔玲, 包宏潔, 等. 經內鏡逆行胰膽管造影術后膽道感染的危險因素分析及預警模型構建. 中華保健醫學雜志, 2022, 24(4): 291-294.
29.	臧鳳, 張永祥, 劉波, 等. 重癥監護病房老年患者多藥耐藥菌的感染分布與來源分析. 中華醫院感染學雜志, 2020, 30(6): 866-871.
30.	孫亭立, 劉合春, 何春華. ERCP 術后血流感染的危險因素及新型感染性標志物的診斷價值. 中華醫院感染學雜志, 2021, 31(17): 2697-2701.

1. Ding YB, Deng B, Liu XN, et al. Synchronous vs sequential laparoscopic cholecystectomy for cholecystocholedocholithiasis. World J Gastroenterol, 2013, 19(13): 2080-2086.
2. Liu B, Wu DS, Cao PK, et al. Percutaneous transhepatic extraction and balloon dilation for simultaneous gallbladder stones and common bile duct stones: a novel technique. World J Gastroenterol, 2018, 24(33): 3799-3805.
3. Manes G, Paspatis G, Aabakken L, et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy, 2019, 51(5): 472-491.
4. 汪曉紅. 膽囊切除術后膽總管結石的內鏡及腹腔鏡治療并膽總管結石復發的相關因素分析. 南京: 南京醫科大學, 2017.
5. ASGE Standards of Practice Committee, Buxbaum JL, Abbas Fehmi SM, et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc, 2019, 89(6): 1075-1105.
6. 魯為朋, 孫禮俠, 王晨, 等. ERBD+LCBDE 與 ENBD+ERCP/EST 在膽總管結石合并中重度急性膽管炎中的近期療效對比. 肝膽胰外科雜志, 2023, 35(1): 40-45.
7. Ricci C, Pagano N, Taffurelli G, et al. Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for management of gallstone disease with biliary duct calculi: a systematic review and network meta-analysis. JAMA Surg, 2018, 153(7): e181167.
8. 陳兵. 腹腔鏡膽總管切開取石一期縫合術 58 例臨床分析. 華西醫學, 2016, 31(9): 1534-1537.
9. Rendell VR, Pauli EM. Laparoscopic common bile duct exploration. JAMA Surg, 2023, 158(7): 766-767.
10. 顧衛東, 趙璇, 何振洲. 普通外科圍手術期疼痛管理上海專家共識(2020 版). 中國實用外科雜志, 2021, 41(1): 31-37.
11. 中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 2001, 81(5): 61-67.
12. Satlin MJ, Lewis JS, Weinstein MP, et al. Clinical and laboratory standards institute and european committee on antimicrobial susceptibility testing position statements on polymyxin B and colistin clinical breakpoints. Clin Infect Dis, 2020, 71(9): e523-e529.
13. 中華人民共和國國家衛生健康委員會. 醫院感染監測標準 WS/T 312-2023. 中國感染控制雜志, 2023, 22(9): 1129-1142.
14. Williams E, Beckingham I, El Sayed G, et al. Updated guideline on the management of common bile duct stones (CBDS). Gut, 2017, 66(5): 765-782.
15. 祝長華. 比較(ERCP+LC)與(LC+LCBDE)兩種術式治療膽囊結石合并膽總管結石療效的 meta 分析. 南昌: 南昌大學, 2023.
16. 賀斌, 張文超, 曾民. 急診 ERCP 治療老年患者膽總管結石繼發急性重癥膽管炎的效果. 中國衛生標準管理, 2023, 14(15): 88-92.
17. 馮其柱, 陳先志, 孫杰, 等. 老年膽總管結石合并急性膽管炎患者 ERCP 術后膽總管結石復發的危險因素分析. 實用醫學雜志, 2023, 39(15): 1945-1949.
18. 樊鵬, 陳治富, 王康. 腹腔鏡膽總管切開取石術后感染情況及危險因素分析. 臨床醫學研究與實踐, 2023, 8(30): 9-12.
19. 丁孟德, 陳中朝, 王林俊, 等. 膽道結石術后醫院感染病原菌及相關影響因素分析. 中華醫院感染學雜志, 2018, 28(1): 84-87.
20. Yin Y, He K, Xia X. Comparison of primary suture and t-tube drainage after laparoscopic common bile duct exploration combined with intraoperative choledochoscopy in the treatment of secondary common bile duct stones: a single-center retrospective analysis. J Laparoendosc Adv Surg Tech A, 2022, 32(6): 612-619.
21. Lyu Y, Cheng Y, Li T, et al. Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis. Surg Endosc, 2019, 33(10): 3275-3286.
22. 胡云龍, 宋正偉, 龍昊, 等. 不同膽總管取石術聯合腹腔鏡膽囊切除術治療膽囊結石合并膽總管結石的療效比較. 成都醫學院學報, 2021, 16(1): 46-49.
23. 劉江, 李棟山. 不同膽總管取石術聯合腹腔鏡膽囊切除術治療膽囊結石合并膽總管結石的療效比較. 甘肅科技, 2021, 37(5): 142-145.
24. 馬勇新, 張旭升, 柳科軍, 等. 惡性膽道梗阻 ERCP 術后早期膽道感染預測模型的建立與評價. 中國普通外科雜志, 2023, 32(8): 1208-1217.
25. 伍嬋璐, 姜瑜, 肖燕. 膽管結石合并膽道細菌感染患者膽汁病原菌及其預后影響因素. 中華醫院感染學雜志, 2021, 31(2): 238-243.
26. 劉立彬, 楊連營, 杜慶云, 等. 膽總管結石合并急性膽管炎患者 PTCD 膽汁與血培養病原菌分布及耐藥性分析. 中華醫院感染學雜志, 2019, 29(5): 726-729.
27. 王超智, 侯軒, 王珊, 等. 膽總管結石合并感染患者 ERCP 取石術膽汁中病原菌種類及耐藥性. 熱帶醫學雜志, 2020, 20(5): 683-686.
28. 梁秋明, 黃潔玲, 包宏潔, 等. 經內鏡逆行胰膽管造影術后膽道感染的危險因素分析及預警模型構建. 中華保健醫學雜志, 2022, 24(4): 291-294.
29. 臧鳳, 張永祥, 劉波, 等. 重癥監護病房老年患者多藥耐藥菌的感染分布與來源分析. 中華醫院感染學雜志, 2020, 30(6): 866-871.
30. 孫亭立, 劉合春, 何春華. ERCP 術后血流感染的危險因素及新型感染性標志物的診斷價值. 中華醫院感染學雜志, 2021, 31(17): 2697-2701.

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Clinical characteristics associated with hospital infections in patients undergoing endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration for common bile duct stones

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