Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2020; 26(14): 1638-1646
Published online Apr 14, 2020. doi: 10.3748/wjg.v26.i14.1638
Clinical and microbiological characteristics of patients with biliary disease
Xue-Xiang Gu, Meng-Pei Zhang, Yan-Feng Zhao, Guang-Ming Huang
Xue-Xiang Gu, Department of Gastroenterology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian 223001, Jiangsu Province, China
Meng-Pei Zhang, Guang-Ming Huang, Department of Gastroenterology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
Yan-Feng Zhao, Center of Laboratory Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
Author contributions: Zhao YF and Huang GM designed the research and Gu XX wrote the paper; Gu XX and Zhang MP analyzed the data and performed the research; Zhao YF contributed new reagents and analyzed data.
Supported by National Natural Science Foundation of China, No. 81802071.
Institutional review board statement: The study protocol was approved by the ethics committee of the Second Affiliated Hospital of Nanjing Medical University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: Data sets are available from the corresponding author. The presented data are anonymized, and the risk of identification is low.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yan-Feng Zhao, MD, PhD, Assistant Professor, Teacher, Center of Laboratory Medicine, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing 210011, Jiangsu Province, China. zhaoyanfeng@njmu.edu.cn
Received: December 19, 2019
Peer-review started: December 19, 2019
First decision: February 18, 2020
Revised: March 6, 2020
Accepted: March 14, 2020
Article in press: March 14, 2020
Published online: April 14, 2020
Processing time: 117 Days and 10.7 Hours
Abstract
BACKGROUND

Biliary diseases are common digestive system disorders which may combine with biliary tract infection such as cholecystitis or cholangitis. Thus, rapid identification of the bacteria and their antibiotic susceptibility profiles are crucial for reducing the mortality of patients with biliary tract infection.

AIM

To identify bacterial species and antibiotic susceptibility for antibacterial therapy and analyze bile cultivation risk factors for increasing detection rates.

METHODS

This retrospective study was conducted from July 2008 to July 2017. In total, 1339 bile samples which were collected during therapeutic endoscopic retrograde cholangiopan-creatography or percutaneous transhepatic cholangiodrainage or other biliary surgeries or biliary drainage were obtained to characterize pathogen spectra, antibiotic susceptibility, and clinical features. Clinical data including age, sex, comorbidities, clinical symptoms, protopathies, and history of biliary tract diseases and surgeries were collated from hospital medical records. Species identification and initial drug susceptibility were further identified by biochemical characterization using the VITEK 2 Compact test.

RESULTS

Positive microbiological findings were observed in 738 samples. The most frequently encountered strains were gram-negative bacteria (74.94%), including Escherichia coli (37.78%), Pseudomonas aeruginosa (8.96%), and Klebsiella pneumoniae (10.29%). Bile bacteria were largely sensitive to carbapenems, piperacillin/tazobactam, and gentamicin. Gram-negative strains had low susceptibility to ceftriaxone, quinolones and ampicillin. Almost the same micro-organisms were present in patients with malignant and benign diseases. The number of samples with Klebsiella pneumoniae in the bile culture were significantly different between patients with malignant and benign diseases (55 vs 30; P = 0.019). Age (P < 0.001), fever (P < 0.001), history of biliary tract diseases and surgeries (both P < 0.001), benign disease (P = 0.002), and the comorbidity chronic renal insufficiency (P = 0.007) affected the positive rates of the bile samples.

CONCLUSION

Gram-negative bacteria were the most commonly isolated biliary bacteria. We determined the major factors associated with positive detection rates. Microbiological analysis of bile samples allowed accurate antibiotic treatments.

Keywords: Microorganism; Antibiotic susceptibility; Bile culture; Biliary diseases; Retrospective study; Detection rate

Core tip: In this large ten year retrospective study, we analyzed bacterial species in bile and their antibiotic susceptibility for antibacterial therapy, and analyzed bile cultivation risk factors to increase detection rates. The most frequently encountered strains were gram-negative bacteria, which were largely sensitive to carbapenems, piperacillin/tazobactam, and gentamicin. Almost the same micro-organisms were present in patients with malignant and benign diseases. Major risk factors for positive detection rates were age, fever, history of biliary tract diseases and surgeries, benign diseases, and the comorbidity chronic renal insufficiency.