Etiología microbiana y patrones de resistencia actuales en la colecistitis aguda litiásica

IF 1.3 4区 医学 Q3 SURGERY Cirugia Espanola Pub Date : 2024-07-01 DOI:10.1016/j.ciresp.2024.03.010
Maite de Miguel-Palacio , Ana-María González-Castillo , María Martín-Ramos , Estela Membrilla-Fernández , Amalia Pelegrina-Manzano , María-José Pons-Fragero , Luis Grande-Posa , Juan-José Sancho-Insenser
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Abstract

Introduction

The current treatment for acute calculous cholecystitis (ACC) is early laparoscopic cholecystectomy, in association with appropriate empiric antibiotic therapy. In our country, the evolution of the prevalence of the germs involved and their resistance patterns have been scarcely described. The aim of the study was to analyze the bacterial etiology and the antibiotic resistance patterns in ACC.

Methods

We conducted a single-center, retrospective, observational study of consecutive patients diagnosed with ACC between 01/2012 and 09/2019. Patients with a concomitant diagnosis of pancreatitis, cholangitis, postoperative cholecystitis, histology of chronic cholecystitis or carcinoma were excluded. Demographic, clinical, therapeutic and microbiological variables were collected, including preoperative blood cultures, bile and peritoneal fluid cultures.

Results

A total of 1104 ACC were identified, and samples were taken from 830 patients: bile in 89%, peritoneal fluid and/or blood cultures in 25%. Half of the bile cultures and less than one-third of the blood and/or peritoneum samples were positive. Escherichia coli (36%), Enterococcus spp (25%), Klebsiella spp (21%), Streptococcus spp (17%), Enterobacter spp (14%) and Citrobacter spp (7%) were isolated. Anaerobes were identified in 7% of patients and Candida spp in 1%. Nearly 37% of patients received inadequate empirical antibiotic therapy. Resistance patterns were scrutinized for each bacterial species. The main causes of inappropriateness were extended-spectrum beta-lactamase–producing bacteria (34%) and Enterococcus spp (45%), especially in patients older than 80 years.

Conclusions

Updated knowledge of microbiology and resistance patterns in our setting is essential to readjust empirical antibiotic therapy and ACC treatment protocols.

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当前急性结石性胆囊炎的微生物病因和耐药模式
导言急性结石性胆囊炎(ACC)目前的治疗方法是早期进行腹腔镜胆囊切除术,并结合适当的经验性抗生素治疗。在我国,有关病菌流行的演变及其耐药性模式的描述很少。我们对 2012 年 1 月 1 日至 2019 年 9 月 9 日期间连续诊断为 ACC 的患者进行了一项单中心、回顾性、观察性研究。排除了同时诊断为胰腺炎、胆管炎、术后胆囊炎、慢性胆囊炎组织学或癌症的患者。研究人员收集了人口统计学、临床、治疗和微生物学变量,包括术前血液培养、胆汁和腹腔液培养。半数胆汁培养物和不到三分之一的血液和/或腹腔样本呈阳性。分离出大肠埃希菌(36%)、肠球菌属(25%)、克雷伯氏菌属(21%)、链球菌属(17%)、肠杆菌属(14%)和枸橼酸杆菌属(7%)。在 7% 的患者中发现了厌氧菌,在 1% 的患者中发现了念珠菌。近 37% 的患者未接受充分的经验性抗生素治疗。对每种细菌的耐药性模式进行了仔细研究。导致治疗不当的主要原因是产生广谱β-内酰胺酶的细菌(34%)和肠球菌属(45%),尤其是在 80 岁以上的患者中。
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来源期刊
Cirugia Espanola
Cirugia Espanola SURGERY-
CiteScore
1.20
自引率
21.10%
发文量
173
审稿时长
53 days
期刊介绍: Cirugía Española, an official body of the Asociación Española de Cirujanos (Spanish Association of Surgeons), will consider original articles, reviews, editorials, special articles, scientific letters, letters to the editor, and medical images for publication; all of these will be submitted to an anonymous external peer review process. There is also the possibility of accepting book reviews of recent publications related to General and Digestive Surgery.
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