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:
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.
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
Research background

Biliary diseases may combine with biliary tract infection such as cholecystitis or cholangitis which possibly lead to severe sepsis and septic shock or even multiple organ dysfunction syndrome and eventually death. However, bile culture requires more time and has lower positive rates. Most related studies were conducted decades ago and lack a large sample size.

Research motivation

Using a large sample size and ten years of study, we fully understand the bacterial species and antibiotic susceptibility for antibacterial therapy in patients with biliary diseases.

Research objectives

The identification of bacterial species and their antibiotic susceptibility for early empiric antibacterial therapy are crucial for reducing the mortality of patients with biliary tract infection.

Research methods

Clinical data were collected from hospital medical records. Species identification and initial drug susceptibility were further identified by biochemical characterization using the VITEK 2 Compact test. All statistical analyses were performed using the SPSS software. Between-group analyses were conducted using the t-test or χ2 test.

Research results

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. We found almost the same micro-organisms present in patients with malignant and benign diseases. 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.

Research conclusions

We found that gram-negative strains had low susceptibility to ceftriaxone, quinolones and ampicillin. In addition, some risk factors such as age, fever, history of biliary tract diseases and surgeries, benign diseases, and the comorbidity chronic renal insufficiency positively influenced the detection rates. Bile samples for microbiological analysis may enable a more accurate selection of antibiotic treatments.

Research perspectives

The risk factors for antibiotic resistance rate and bacterial resistance genes should be analyzed.