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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Microbial spectrum and drug resistance of pathogens cultured from gallbladder bile specimens of patients with cholelithiasis: A single-center retrospective study
Xiao-Ming Huang, Zong-Jin Zhang, Nan-Rong Zhang, Jian-Dong Yu, Xiang-Jun Qian, Xian-Hua Zhuo, Jia-Yu Huang, Wei-Dong Pan, Yun-Le Wan
Xiao-Ming Huang, Xiang-Jun Qian, Wei-Dong Pan, Department of Pancreatic-Hepato-Biliary-Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Xiao-Ming Huang, Zong-Jin Zhang, Jian-Dong Yu, Xiang-Jun Qian, Wei-Dong Pan, Yun-Le Wan, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Zong-Jin Zhang, Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Nan-Rong Zhang, Department of Anesthesiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Jian-Dong Yu, Yun-Le Wan, Department of Hepatobiliary Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Xian-Hua Zhuo, Department of Otorhinolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510520, Guangdong Province, China
Jia-Yu Huang, Department of Urology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Author contributions: Huang XM, Zhang ZJ, and Zhang NR contributed equally to this study; Huang XM, Zhang ZJ, and Zhang NR contributed to study design, patient inclusion and exclusion, data collection, data analysis and interpretation, and manuscript writing; Yu JD, Qian XJ, Zhuo XH, and Huang JY contributed to data collection; Pan WD and Wan YL contributed equally to the work; Pan WD and Wan YL contributed to critical revision of the manuscript for important intellectual content and study supervision; all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the Sixth Affiliated Hospital of Sun Yat-sen University (Approval No. 2022ZSLYEC-352).
Informed consent statement: The informed consent was waived in these patients.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Yun-Le Wan, MD, PhD, Department of Hepatobiliary Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, No. 26 Yuancun Erheng Road, Guangzhou 510655, Guangdong Province, China. wanyunle@mail.sysu.edu.cn
Received: August 28, 2022
Peer-review started: August 28, 2022
First decision: September 12, 2022
Revised: September 26, 2022
Accepted: November 20, 2022
Article in press: November 20, 2022
Published online: December 27, 2022
ARTICLE HIGHLIGHTS
Research background
Bacterial infection is an important cause of cholelithiasis or gallstones and interferes with its treatment.
Research motivation
Identified microbial spectrum and drug resistance of pathogens cultured from gallbladder bile specimens is helpful for targeted preventive and therapeutic drugs in the perioperative period.
Research objectives
Investigate the bile microbial spectrum of patients with cholelithiasis and the drug susceptibility patterns in order to establish an empirical antibiotic treatment for cholelithiasis-associated infection.
Research methods
A retrospective single-center study was conducted on patients diagnosed with cholelithiasis between May 2013 and December 2018.
Research results
The presence of common bile duct stones (OR = 5.4, 95%CI: 1.3-21.9, P = 0.03) and longer operation time (> 80 min) (OR = 4.3, 95%CI: 1.4-13.1, P = 0.01) were identified as independent risk factors for positive bile culture. Gram-negative bacteria were detected in 28 positive bile specimens, and Escherichia coli (E. coli) (19/28) and Klebsiella pneumoniae (5/28) were the most frequently identified species. Gram-positive bacteria were present in 10 specimens. All the isolated E. coli strains were sensitive to carbapenems, with the exception of one imipenem-resistant strain. K. pneumoniae showed a similar resistance spectrum to E. coli. Enterococcus spp. was largely sensitive to glycopeptides and penicillin, except for a few strains of E. faecium.
Research conclusions
The presence of common bile duct stones and longer operation time were identified as independent risk factors for positive bile culture in patients with cholelithiasis. The most commonly detected bacterium was E. coli. The combination of β-lactam antibiotics and β-lactamase inhibitors prescribed perioperatively appears to be effective against bile pathogens and is recommended.
Research perspectives
To explore the characteristics of patients infected with drug-resistant bacteria and the prevention and treatment of drug-resistant bacteria.
