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Objective:To analyze the distribution of pathogenic bacteria in bile culture in patients with common bile duct stones and biliary tract infections, in order to guide clinical optimization of antibiotics application.Methods:From March 30, 2017 to December 31, 2021, at Affiliated Hospital of Qingdao University, 753 patients with common bile duct stones and biliary tract infections and received endoscopic retrograde cholangiopancreatography were selected. Bile samples were obtained for bacterial culture, strain type identification and drug sensitivity test in order to analyze bile pathogenic bacteria distribution, change trend and drug resistance. Chi-square test was used for statistical analysis.Results:From 2017 to 2021, the total positive rate of bile culture in 753 patients with choledocholithiasis complicated with biliary tract infection was 90.17% (679/753). From 2017 to 2021, the positive rates of bile culture were 82.05% (64/78), 88.81% (119/134), 88.03% (125/142), 93.87% (199/212), and 91.98% (172/187), respectively, and the difference was statistically significant ( χ2=10.78, P=0.029). The positive rate of bile culture in 2017 was lower than those in 2020 and 2021, and the differences were statistically significant ( χ2=9.43 and 5.57, P=0.002 and 0.018). There were no significant differences in the positive rates of bile culture among the other years (all P>0.05). A total of 1 033 pathogenic bacteria were detected in the 679 bile specimens with positive bile culture results. Among which the total proportion of Gram-negative bacilli was 57.02% (589/1 033), and from 2017 to 2021 the proportions were 66.38% (77/116), 66.47% (111/167), 59.43% (104/175), 54.75% (173/316), and 47.88% (124/259), respectively. The total proportion of Gram-positive cocci was 41.05% (424/1 033), and from 2017 to 2021 the proportions were 31.90% (37/116), 31.74% (53/167), 38.86% (68/175), 44.30% (140/316), and 48.65% (126/259), respectively. The total proportion of fungus was 1.94% (20/1 033), and from 2017 to 2021 the proportions were 1.72% (2/116), 1.80% (3/167), 1.71% (3/175), 0.95% (3/316), and 3.47% (9/259), respectively. From 2017 to 2021, the proportion of Gram-negative bacilli gradually decreased, while the proportion of Gram-positive cocci gradually increased, and the differences were statistically significant ( χ2=20.14 and 17.91, P<0.001 and =0.001). From 2017 to 2021, the change in the proportion of fungus was not statistically significant ( P>0.05). The main Gram-negative bacilli in the bile culture were Escherichia coli (31.36%, 324/1 033) and Klebsiella pneumoniae (12.68%, 131/1 033); the main Gram-positive cocci were Enterococcus faecalis (14.04%, 145/1 033) and Streptococcus salivarius (4.36%, 45/1 033). From 2017 to 2021, the proportions of Escherichia coli were 39.66% (46/116), 38.92% (65/167), 33.14% (58/175), 28.48% (90/316), and 25.10% (65/259), respectively, with gradual decrease and the difference was statistically significant ( χ2=14.34, P=0.006). From 2017 to 2021 the detection rates of extended-spectrum β-lactamase (ESBL) in Escherichia coli and Klebsiella pneumoniae were 30.43% (14/46), 26.15% (17/65), 29.31% (17/58), 38.89% (35/90), 40.00% (26/65), and 4/15, 20.00% (5/25), 20% (5/25), 24.32% (9/37), and 31.03% (9/29), and there were no significant differences in the detection rates of ESBL between different years (both P>0.05). Conclusions:From 2017 to 2021, the positive rate of bile culture in patients with choledocholithiasis complicated with biliary tract infection showed an overall increasing trend. Gram-negative bacilli were still dominated in bile pathogenic bacteria, while the proportion of Gram-positive cocci remarkably increased, and the bile bacterial spectrum significantly changed. Clinicians should adjust the antibiotic dosing regimens according to the variation of bacterial spectrum and drug resistance.
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Objective To investigate the role of multi-disciplinary team (MDT) in the treatment of complex cholestatic liver injury after liver transplantation. Methods MDT consultation was conducted to clarify the causes and therapeutic strategies for one case of complex cholestatic liver injury after liver transplantation admitted to Liver Transplantation Center of the First Hospital of Jilin University on June 23, 2020. And the role of MDT in the treatment of complex cholestatic liver injury after liver transplantation was summarized. Results The patient presented with abnormal liver function after liver transplantation. The diagnosis of biliary stricture, rejection and biliary tract infection was confirmed successively. Endoscopic retrograde cholangiopancreatography (ERCP) stent internal and external double drainage, glucocorticoid shock and anti-infection therapy yielded low clinical efficacy. After MDT consultation, complex cholestatic liver injury after liver transplantation was confirmed. It was suggested to optimize the immunosuppressive regimen based on the exclusion of rejections by pathological examination, deliver targeted anti-infection interventions and prevent the potential risk of concomitant drug-induced liver injury. The patient was discharged after proper recovery. Conclusions The causes of complex cholestatic liver injury after liver transplantation are diverse, and the condition changes dynamically. MDT consultation are performed to deepen the understanding of this disease, strengthen the classification of diagnosis and treatment ideas and enhance the precision and efficacy of corresponding treatment.
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Objective To comparatively analyze the difference and characteristics of high mobility group box-1 protein(HMGB1) level with the levels in the patients with different severities of acute biliary tract infection (ABTI) to provide reference for its clinical diagnosis and treatment .Methods One hundred cases of ABTI in our hospital were divided into the mild group (48 cases) ,moder-ate group (29 cases) and severe group (23 cases) according to the severity of the disease .The HMGB1 detection results were com-pared among 3 groups and the differences in different disease types ,sex and age were analyzed .Results (1)The HMGB1 level had statistically significant difference among 3 groups (P0 .05) ,but in the severe group ,the HMGB1 level in males was significantly higher than that in females (P 0 .05) ,while in the moderate group and severe group ,the HMGB1 level in the patients aged > 60 years old was significantly higher than that in the patients aged ≤60 years old(P<0 .05);(4) in the above 3 groups ,the HMGB1 level in the patients with acute cholecystitis was signifi-cantly higher than that in the patients with acute cholangitis (P<0 .05) .Conclusion The study results analysis indicates that the severe the ABTI disease condition ,the serum HMGB1 level is also accordingly and relatively increased ,in the patients with different severity degrees of ABTI ,the serum HMGB1 level has significant differences in age ,sex and disease type ,which prompts that the HMGB1 level can be used as the laboratory index for predicting and reflecting the ABTI severity and can be paid attention to .
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Objective To investigate the pathogen distribution and drug resistance of biliary tract infection in patients with cholelithiasis, and to summarize the clinical experience.Methods160 patients with cholelithiasis were analyzed.The proportion of patients with biliary tract infection was counted.The bile and venous blood were collected and the distribution of pathogens was detected.The patients were also analyzed for the drug resistance.ResultsThe incidence of biliary tract infection was 62.5%, the positive rate of bile culture was 62.5%, and the positive rate of blood test was 37.5% for 160 patients with cholelithiasis.Gram-positive bacteria include Escherichia coli, Enterococcus faecium, Staphylococcus, Gram-negative bacteria, including Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, etc.;Gram-positive bacteria for the large Methicillin and erythromycin resistance is higher, Gram-negative bacteria for ampicillin and levofloxacin higher resistance.ConclusionThe pathogen distribution and drug resistance of biliary tract infection in patients with cholelithiasis are analyzed.The clinical pathogens are widely distributed.At the same time, the pathogens have different resistance to different antimicrobial agents.Therefore, clinical use should be reasonable choice when using antimicrobial agents, With a view to give full play to drug effects.
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Objectives To access the bacteriology in patients with sepsis due to biliary tract infection to provide a basis for empirical selection of proper antibiotic treatment.Methods This is a single-center retrospective study on 214 patients with biliary tract infection admitted from August 2014 to July 2016 to the surgical intensive care units (ICU) of The First Affiliated Hospital of Sun Yat-sen University.To study the demographic information,sequential organ failure assessment (SOFA),usage of antibiotics before ICU and duration of ICU were analyzed.Bile,peritoneal drainage and blood samples were collected.Results 47 septic shock patients and 25 septic patients due to biliary tract infection were enrolled in the trial.The two groups (the shock group vs.the sepsis group) had a significant difference in the duration of ICU stay [(6.4 ± 4.6) d vs.(2.3 ± 1.8) d,P ＜ 0.05].48 strains of pathogens were isolated from the bile samples.The major pathogens were Escherichia coli (E.coli) (n =23,47.9％),Enterococcus faecalis (n =8,16.7％) and Enterococcus faecium (n =2,4.2％).80 strains of pathogens were isolated from the peritoneal drainage culture samples.E.coli,pseudomonas aeruginosa,and Klebsiella pneumoniae ranked the top 3 species,accounting for 26.3％,11.3％ and 7.5％,respectively.The sensitivity of E.coli isolated from bile to amikacin,imipenem and panipenem were all over 90.0％.Conclusions E.coli was the principal gram-negative bacterium in biliary infection induced sepsis.Early administration of carbapenemes may reduce the occurrence of septic shock in these patients.
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Objective To analyze the current status of bacterial spectrum and drug resistance in community-acquired biliary tract infection to provide a basis for clinical medication .Methods The patients with community-acquired biliary tract infection (ex-periment group) and the patients with biliary tract diseases without biliary tract infection (control group) derived from the native ar-ea treated in this hospital from September 2014 to January 2016 were selected .The bile juice was intraoperatively extracted for con-ducting the bacterial culture and drug susceptibility test .Results Thirteen specieses (60 strains) of bacteria were isolated in the ex-periment group .The top 3 specieses were Escherichia coli (35 .0% ) ,Klebsiella pneumonia (21 .7% ) and Enterobacter cloacae (10 .0% ) .Eight specieses (13 strains) of bacteria were isolated in the control group .The top 3 specieses were Escherichia coli (30 .8% ) ,Klebsiella pneumonia(15 .4% ) and Lactococcus garvieae (15 .4% ) .The proportions of drug resistant strains in the two groups were 95 .0% and 84 .6% respectively (P>0 .05) .The proportions of multiple drug resistant strains in the two groups were 30 .0% and 7 .7% respectively(P>0 .05) .The occurrence rates of multiple drug resistance in the top 3 specieses of bacteria in the experiment group were 61 .9% ,7 .7% and 16 .7% respectively .Conclusion The bacterial spectra of community-acquired acute bili-ary tract infection in the native area are dominated by Gram negative bacteria .The total bacterial drug resistance is serious ,but the drug resistance situation in different bacteria pathogens is different .
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Objective To analyze the distribution and drug resistance of bile-isolated pathogens in Xiamen area ,providing evi-dence for clinical use of antibiotics .Methods Bile cultures and antibiotic susceptibility tests were performed on strains isolated from the First Affiliated Hospital of Xiamen University .WHONET 5 .6 was used for data analysis .Results In 35 out of 217 samples ,2 kinds of pathogens were isolated .Among these ,Enterococcus and Enterobacteriaceae coinfection was most common .There were 252 strains isolated totally ,with 83 gram-positive strains(32 .9% ) ,165 gram-negative strains (65 .5% ) and 4 fungi strains (1 .6% ) . Escherichia coli ,Enterococcus faecalis and Klebsiella pneumoniae were three of the most common pathogens isolated .Pseudomonas aeruginosa and Acinetobacter baumannii were two of the most common nonfermenters isolated .The resistance rates of Enterobacte-riaceae to aminoglycosides ,fourth generation cephalosporins ,carbapenems or piperacillin/tazobactam were lower than 40 .0% .The resistance rate of Escherichia coli to quinolones was higher than 50 .0% .Enterococcus faecalis or enterococcus faecium were less re-sistant to vancomycin ,linezolid and tigecycline .The resistance rates of enterococcus to high concentration of streptomycin or genta-micin were lower than 30 .0% .Conclusion The top three common pathogens isolated from bile are Escherichia coli ,Enterococcus faecalis and Klebsiella pneumonia in Xiamen area .Infections by Enterococcus together with Enterobacteriaceae account for large numbers of coinfection cases .The resistance rates to cephalosporin or quinolones of pathogens causing biliary tract infections have increased dramatically .
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Objective To investigate the changes of pathogens and antimicrobial susceptibility in patients with biliary tract infection during the past 30 years.Methods During the periods of 1981-1984,1988-1998 and 2003-2013,each 100 patients treated with common bile duct exploratoration were selected from every period.Biopsied bile specimens were performed with bacteria culture and antimicrobial susceptibility tests.This study reviewed the changes in bilary pathogens and antimicrobial susceptibility test.Results From 1981 to 1984,the most common pathogens were Escherichia coli (59.2％) and Klebsiella pneumonia (28.9％).Mixed infection of these pathogens accounted for 16.9％.From 1988 to 1998,the types of pathogens significandy increased.Escherichia coli (33.1％) and Klebsiella pneumonia (16.5％) accounted for less than 50％.Mixed infection with Escherichia coli and Pseudomonas aeruginosa was the most common type.From 2003 to 2013,gram-negative bacteria were still the main pathogens,accounting for 61.8％.Escherichia coli and Pseudomonas aeruginosa accounted for 20.1％ and 10.4％,respectively.Gram-positive bacteria increased sigrnificantly.Enterococcusfaecium (22.2％) ranked the first.Mixed infection increased (36％),of which more than 50％ was mixed pathogens of Escherichia coli and Enterococcusfaecium.The incidence of fungi infection also increased (5.6％).Conclusions There was a remarkable change of pathogen category in the biliary infections over the past years.With an increase of gram-positive bacteria and fungi infection in clinical practice,antimicrobial susceptability results could be considered in choosing appropriate drug to avoid bacterial resistance.
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Objective:To analyze the pharmaceutical care performed by clinical pharmacist for one patient with biliary tract infec -tion to investigate the role of clinical pharmacists in clinical treatment .Methods:The clinical pharmacist supervised the whole process of treatment for the patient and optimized the treatment regimen together with the clinical doctors to achieve good efficacy .Results:With the cooperation of clinical pharmacist , the clinical doctors changed the treatment drugs to avoid the potential adverse drug reac -tions until the patient was cured .Conclusion:The participation of clinical pharmacist in the pharmaceutical care for the patients with biliary tract infection can provide a new thought of working mode .
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Objective To find out the main pathogenic bacteria distribution and sensitivity to antibiotics in patients post PTCD for malignant biliary obstruction ,to evaluate the therapeutic effectiveness of antibiotics and provide evidences for rational use of antibiotics .Methods The clinical data were collected and analyzed retrospectively from 423 PTCD cases with malignant biliary obstruction from September 2013 to October 2014 .Results Among 423 patients underwent PTCD ,101 patients were confirmed with infections .67 patients showed positive pathogenic bacteria culture .A total of 94 strains of pathogenic bacteria were detected .There were 62 strains of gram negative bacteria (65 .96% ) and 32 strains of gram positive bacteria (34 .04% ) . The main pathogenic bacteria were klebsiella pneumoniae , Escherichia coli ,enterococcus faecalis and Enterobacter cloacae . Klebsiella pneumoniae and Escherichia coli are the two gram negative bacteria most resistant to antibiotics .The three popular gram negative bacilli in this study had the lowest resistance to imipenem/cilastatin ,piperacillin/tazobactam and amikacin .The three main gram positive bacteria were most sensitive to daptomycin ,linezolid and vancomycin .The total effective rate of anti-biotic treatments for post PTCD infections was 88 .1% .Conclusion Our hospital had an appropriate treatment plan with antibi-otics to control the infections post percutaneous transhepatic cholangio-drainage for malignant biliary obstruction .According to the results of drug sensitivity test ,ceftriaxone had high resistance rate .The outcome with ceftriaxone treatment was unsatis-factory .Clinical pharmacists should advise doctors to reduce the usage of ceftriaxone .Glycopeptide antibiotics can be used to control methicillin-resistant staphylococcus (MRS) gram positive bacteria .
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Objective To understand the main pathogenic bacteria distribution and drug susceptibility in the common bile duct calculi with infection ,so as to provide the basis for rational use of antimicrobial agents .Methods Data′s of 296 cases of bile specimens treated from January 2011 to December 2013 were retrospectively surveyed and drug resistance of bacteria culture results were analyzed .Results Among all the 296 cases ,there were 199 cases of pathogenic bacteria in bile specimens ,the positive rate was 67 .23% ;among them ,there were 21 cases of two kinds of bacteria ,a total of 220 strains of pathogenic bacteria were detected ,and among them there were 158 strains of gram negative bacteria ,accounting for 71 .82% ;there were 46 strains of gram positive bacte‐ria ,accounting for 20 .91% ;there were 16 strains of fungi ,accounting for 7 .27% ;the lowest resistance of gram negative bacilli lies in amikacin ,followed by tazobactam ,aztreonam ,three to four generations of cephalosporins and quinolone .Gram negative bacilli has the highest drug resistance to pseudomonas aeruginosa and e .coli ,and it has a drug resistant rate higher than 50 .00% to most anti‐microbial drugs .Gram positive cocci has 0 drug resistance rate to add ring element ,has a drug resistance rate lower than 30 .00% to vancomycin and rina thiazole amine ,and has highest drug resistance rate (70 .00% -100 .00% ) to erythromycin ,clindamycin and chlorine lincomycin .Conclusion Among all the 296 cases of common bile duct calculi bile with biliary tract infection ,the main path‐ogenic bacteria were e .coli ,klebsiella pneumoniae ,eosinophilic malt narrow and excrement enterococcus bacterium ;and the drug re‐sistance to penicillin is highest .
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OBJECTIVE To investigate the drug resistance of Escherichia coli in biliary tract infection and genotype of ESBLs.METHODS Antimicrobial susceptibility test was performed using Kirby-Bauer method.The genotypes of ESBLs were detected by PCR.RESULTS The detection rate of ESBLs producing bacteria was 32.4%(23 strains),and the drug-sensitivity test indicated that E.coli was sensitive to imipenem,meropenem and cefoperazone/subactam,but these ESBLs producing strains were resistant to other antimicrobial agents.ESBLs were identified as TEM type in 16 strains,SHV type in 4 strains,CTX-M type in 12 strains and OXA type in 5 strains.CONCLUSIONS ESBLs-producing E.coli in biliary tract infections show strous resistance.TEM and CTX-M are the most common ESBLs genotypes.
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OBJECTIVE To find out the changes of pathogens and their sensitivity to antibiotics in bile samples of patients with biliary tract infection of our hospital during last six years. METHODS The data of 359 strains of microbes found in 371 patients with positive bile culture from Jan 2001 to Dec 2006 and their sensitivity to antibiotics were statistically analyzed. RESULTS There were 84 and 188 positive samples respectively in 140 samples during the first half of this study (2001-2003)and 231 ones during the second half (2004-2006) as well as 105 and 254 strains cultured. Respectively, Gram-negative bacteria accounted for 60.0%, and 50.8% and Gram-positive cocci 34.3%, and 40.2% and fungi 5.7%, and 9.0%; Escherichia coli was the major one and accounted for 36.2%, and 31.1%, with the increasing incidence of the positive rates of its ESBLs (34.2% vs 60.8%, P
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OBJECTIVE:To study the stability of mixture of ciprofloxacin injection and metronidazole in glucose injection at high temperature(50℃～70℃)and at room temperature((20?1)℃)storage METHODS:UV-spectrophotometry method was used for determining the contents of ciprofloxacin and metronidazole The changes in the content,pH value and appearance were observed by classical constant-temperature experiment and room temperature storage RESULTS:The linearity ranges for ciprofloxacin and metronidazole were 1 00～10 02?g/ml and 2 01～20 08?g/ml;the average recoveries were(101 30?4 28)% and(99 58?1 63)%,respectively The heat decomposition products at 70℃ for 8 hours did not interfere with the assay The relative contents of ciprofloxacin and metronidazole were more than 95% and there were no significant changes of the pH value and the color with accelerating experiment for 8 hours at 50℃～70℃ and for 120 hours at (20?1)℃ CONCLUSION:We found that admixture of ciprofloxacin with metronidazole in glucose solution was stable at high temperature for 8 hours and at room temperature for 120 hours Ciprofloxacin injection was compatible with metronidazole in glucose injection
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OBJECTIVE To evaluate the safety and clinical efficacy of cefoperazone/sulbactam in the treatment of biliary tract infections.METHODS In this prospective multicenter study,159 hospitalized patients with biliary tract infections received cefoperazone/sulbactam,and the clinical and bacteriological efficacy as well as the side effects were evaluated.RESULTS The clinical effective rate of cefoperazone/sulbactam in the treatment of biliary tract infections was 86.78%.After treatment,the body temperature reduced to normal rapidly,the average time of defervescence was 3.09?1.81 days.Pathogen eradication rate was 85.71%.No adverse reactions were reported during the study period.CONCLUSIONS Cefoperazone/sulbactam can be used as one of antibiotics of choice in the initial empirical therapy for biliary tract infections.
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OBJECTIVE:To study the composition of pathogenic bacteria and drug resistance in biliary tract infection for clinicians' reference about rational application of antibiotics. METHODS:Bacteria culture and drug susceptibility analysis were performed for the bile samples of 235 cases. RESULTS:The detection rate of pathogenic bacteria in bile was 61.7%,with gram-negative bacilli representing 59.3%,gram-positive bacilli 38.9% and Candida mycoderma 1.8%. With regard to constituent ratios of the bacteria,leading the first 4 places were enterococci(37.7%),Escherichia coli(29.3%),Klebsiella(18.6%) and Pseudomonas aeruginosa(5.4%). The main gram-negative bacilli were sensitive to imipenem and amikacin; whereas Enterococci were sensitive to vancomycin,amphemycin,ampicillin,penicillin and high concentration of gentamicin. ESBLs-producing Escherichia coli and Klebsiella totaled 30 strains,and the ESBLs-producing rate was 37.5%. CONCLUSION:Bile bacteria culture and drug resistance analysis serve as reference for clinical rational use of antibiotics.
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OBJECTIVE:To observe the therapeutic effect of compound glycyrrhizin on acute biliary tract infection com?bined with abnormal liver function.METHODS:The patients were randomly divided into trial group(141cases)and control group(120cases).The control group received ATP,CoA and inosine,and the trial group received compound glycyrrhizin60～120ml/d in addition to the treatment for control group.RESULTS:In trial group,113cases were remarkedly effective and28cases effective with a total effective rate of100%,and in control group,79cases were remarkedly effective and29cases effective with a total effective rate of90%.CONCLUSION:Compound glycyrrhizin has the anti-inflammatory effect and can protect the cell membrane of liver cells,shorten the hospital stay duration and decrease the occurrence of postoperative complications.
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OBJECTIVE:To evaluate the3pharmacotherapeutic schemes for biliary tract infections by pharmacoeconomic method.METHODS:Scheme A:cefazolin+metronidazole;Scheme B:ampicillin+gentamicin+metronidazole;Scheme C:lome?floxacin injection+metronidazole.These three schemes were retrospectively analysed with cost-effectiveness analy?sis.RESULTS:Scheme C had the lowest cost-effectiveness ratio with the highest total effective rate.CONCLUSION:Scheme C is the best one.