The Biliary Microbiology And Antimicrobial Susceptibilities With Acute Cholangitis In Different Grades

ObjectiveTo investigate the distribution of pathogenic bacteria in different grades of acute cholangitis and evaluate the resistance of pathogenic bacteria to antibiotics,in order to provide reference for clinical treatment of acute cholangitis.MethodsThis retrospective observational study enrolled patients in the General Hospital of Ningxia Medical University who met the diagnostic criteria of Tokyo Guidelines 2018(TG18)from Sep.2014 to Sep.2018.Data on the general situation,laboratory examinations,biliary microbiology and drug resistance of acute cholangitis were collected.The TG18 severity grading criteria were applied.In order to analyze,explore and summarize the antibiotic resistance of acute cholangitis in different grades.Results1.A total of 285 patients were included.Patients ranged in age from 20 years to 93 years;the median age was 69.41 years.Of the 285 patients,167 patients were male and 118 patients were female.The peak age of onset was 56-85 years old,with an average hospitalization time of 7.70 days.2.Patients with mild acute cholangitis were younger than those with moderate or severe cholangitis(64.19±11.45 vs 71.90±13.36 or 71.11±9.95,P < 0.05),and there was no significant difference between moderate and severe cholangitis.The proportion of mild and moderate patients without fever(mild 36.9%,moderate 35.8%)was significantly higher than that of severe patients(17.9%).The level of body temperature is positively correlated with the grade of disease.3.In this study,positive rates of bile cultures among patients were 91.4%.In addition,348 clinical isolates were collected.The most common pathogens were Escherichia coli(36.5%),Klebsiella pneumoniae(12.86%),and Enterococcus faecium(10.1%).The isolation rate of pathogens in different grades is different.4.Amikacin,piperacillin/tazobactam,cefoperazone/sulbactam and carbapenems had good effects on the Gram-negative bacteria.Gram-positive bacteria were highly sensitive to tigecycline,linezolid and teicoplanin.5.There was no significant difference between the initial antibiotic selection and the length of hospitalization.Patients who had polymicrobial growth in bile culture had a longer hospital stay,but there was no significant difference.Conclusion1.Among the main pathogenic bacteria of mild acute cholangitis,Gram negative bacteria included Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa.The main sensitive antibiotics were amikacin,imipenem,meropenem and cefoperazone/sulbactam.Gram positive bacteria included Enterococcus faecium,Streptococcus viridans and Enterococcus faecalis.The main sensitive antibiotics were teicoplanin,linezolid,vancomycin,tigecycline,quinupristin/dalfopristin and gentamicin.2.Among the main pathogenic bacteria of moderate acute cholangitis,Gram negative bacteria included Escherichia coli,Klebsiella pneumoniae and Enterobacter cloacae.The main sensitive antibiotics were amikacin,imipenem,meropenem,piperacillin/tazobactam,cefoperazone/sulbactam and cefotetan.Gram positive bacteria included Enterococcus faecium,Enterococcus casselifavus,Enterococcus faecalis and Streptococcus viridans.The main sensitive antibiotics were teicoplanin,tigecycline,linezolid and moxifloxacin.3.Among the main pathogenic bacteria of severe acute cholangitis,Gram negative bacteria included Escherichia coli,Klebsiella pneumoniae and Enterobacter cloacae.The main sensitive antibiotics were amikacin,imipenem,meropenem,cefotetan and piperacillin/tazobactam.Gram positive bacteria included Enterococcus faecium.The main sensitive antibiotics were teicoplanin,tigecycline,linezolid,moxifloxacin and vancomycin.4.In this study,only 0.3% of anaerobes were cultured,anaerobes were not the main pathogens of acute cholangitis.Whether anti-anaerobic agents should be added routinely is debatable.