Epidemiology and Resistance Patterns of Bacterial and Fungal Colonization of Biliary Plastic Stents: A Prospective Cohort Study

Lübbert, Christoph; Wendt, Karolin; Feisthammel, Jürgen; Moter, Annette; Lippmann, Norman; Busch, Thilo; Mössner, Joachim; Hoffmeister, Albrecht; Rodloff, Arne C.

doi:10.1371/journal.pone.0155479

Cited by 44 publications

(20 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Reflecting their differing virulence, and in agreement with a recent large multicenter trial on biliary infections, enterobacterales comprised almost 60% and enterococci only 20% of blood culture isolates [2]. In line with previous studies, our multivariate analysis found the presence of a biliary prosthesis an independent predictor for enterococcal isolation from bile [3,9,12,13]. The Tokyo guideline recommends empirical treatment covering enterococci in severe community-acquired cholangitisand in health-care associated infections if patients are colonized or enterococci are otherwise of concern.…”

Section: Discussionsupporting

confidence: 88%

Use of microbiological and patient data for choice of empirical antibiotic therapy in acute cholangitis

et al. 2020

View full text Add to dashboard Cite

Background: Ineffective antibiotic therapy increases mortality of acute cholangitis. The choice of antibiotics should reflect local resistance patterns and avoid the overuse of broad-spectrum agents. In this study, we analysed how results of bile and blood cultures and patient data can be used for selection of empirical antibiotic therapy in acute cholangits. Methods: Pathogen frequencies and susceptibility rates were determined in 423 positive bile duct cultures and 197 corresponding blood cultures obtained from 348 consecutive patients with acute cholangitis. Patient data were retrieved from the medical records. Associations of patient and microbiological data were assessed using the Chi-2 test and multivariate binary logistic regression. Results: In bile cultures, enterobacterales and enterococci were isolated with equal frequencies of approximately 30% whereas in blood cultures, enterobacterales predominated (56% compared to 21% enterococci). Antibiotic resistance rates of enterobacterales were > 20% for fluorochinolones, cephalosporines and acylureidopenicillins but not for carbapenems (< 2%). The efficacy of empirical therapy was poor with a coverage of bacterial bile and blood culture isolates in 51 and 69%, respectively. By multivariate analysis, predictors for pathogen species, antibiotic susceptibility and expected antibiotic coverage were identified. Conclusions: In unselected patients treated for acute cholangitis in a large tertiary refferential center, use of carbapenems seems necessary to achieve a high antibiotic coverage. However, by analysis of patient and microbiological data, subgroups for highly effective carbapenem-sparing therapy can be defined. For patients with community-acquired cholangitis without biliary prosthesis who do not need intensive care, piperacillin/tazobactam represents a regimen with an expected excellent antibiotic coverage.

show abstract

Section: Discussionsupporting

confidence: 88%

Use of microbiological and patient data for choice of empirical antibiotic therapy in acute cholangitis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…were isolated from 55.9% of the patients [13]. Due to these high rates of bacterial colonization, the authors suggested microbiological testing of explanted biliary stents as a helpful diagnostic procedure to identify the causative pathogens of AC [13]. Schneider et al .…”

Section: Discussionmentioning

confidence: 99%

“…found in patients who had undergone BD stenting [10]. Bile from healthy individuals is sterile; however, in patients with BD pathologies, bacterial or fungal colonization of the bile without clinical signs of infection may occur [11,12] in up to 100% of patients with biliary stents [13], which can be difficult to discriminate from AC [14]. …”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Multi-Drug Resistant Pathogens and Failure of Empiric First-Line Therapy in Acute Cholangitis

et al. 2017

Self Cite

View full text Add to dashboard Cite

BackgroundAcute cholangitis (AC) requires the immediate initiation of antibiotic therapy in addition to treatment for biliary obstruction. Against a background of an increasing prevalence of multi-drug resistant (MDR) bacteria, the risk factors for the failure of empiric therapy must be defined.MethodsUsing a pathogen-based approach, 1764 isolates from positive bile duct cultures were retrospectively analyzed to characterize the respective pathogen spectra in two German tertiary centers. Using a patient-based approach, the clinical and laboratory data for 83 patients with AC were assessed to identify risk factors for AC with pathogens resistant to the applied empiric therapy.ResultsBile cultures were predominantly polymicrobial, and empiric antibiotic therapies did not cover the full biliary pathogen spectrum in 78% of cases. MDR bacteria were isolated from the bile of 24/83 (29%) patients. The univariate risk factors for biliary MDR bacteria were male sex, nosocomial AC, prior antibiotic exposure and prior biliary stenting, of which biliary stenting was the only independent risk factor according to multivariate analysis (OR = 3.8; 95% CI 1.3–11.0, P = 0.013). Although there were no significant differences in survival or hospital stay in AC patients with and without detected biliary MDR pathogens, the former more often had a concomitant bloodstream infection (58% vs. 24%; P = 0.019), including those involving MDR pathogens or fungi (21% vs. 2%; P = 0.007).ConclusionPatients with biliary stents who develop AC should receive empiric therapy covering enterococci and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. These patients are at an increased risk for bloodstream infections by MDR pathogens or fungi.

show abstract

“…In addition to Gram staining or immunohistochemical methods, FISH combines molecular detection of microorganisms with fluorescence microscopy and has been increasingly used for analysis of biofilm‐associated infections . FISH can be applied to in vitro samples as well as to ex vivo samples from animal models or patients . Since FISH‐probes hybridize ribosomal RNA, the signal intensity correlates to the ribosome content and consequently activity of the cells.…”

Section: Bacteriological Aspects Of Odri Studiesmentioning

confidence: 99%

Recommendations for design and conduct of preclinical in vivo studies of orthopedic device‐related infection

Moriarty

Harris

Mooney

et al. 2019

Journal Orthopaedic Research

Self Cite

View full text Add to dashboard Cite

Orthopedic device-related infection (ODRI), including both fracture-related infection (FRI) and periprosthetic joint infection (PJI), remain among the most challenging complications in orthopedic and musculoskeletal trauma surgery. ODRI has been convincingly shown to delay healing, worsen functional outcome and incur significant socio-economic costs. To address this clinical problem, ever more sophisticated technologies targeting the prevention and/or treatment of ODRI are being developed and tested in vitro and in vivo. Among the most commonly described innovations are antimicrobial-coated orthopedic devices, antimicrobial-loaded bone cements and void fillers, and dual osteo-inductive/antimicrobial biomaterials. Unfortunately, translation of these technologies to the clinic has been limited, at least partially due to the challenging and still evolving regulatory environment for antimicrobial drugdevice combination products, and a lack of clarity in the burden of proof required in preclinical studies. Preclinical in vivo testing (i.e. animal studies) represents a critical phase of the multidisciplinary effort to design, produce and reliably test both safety and efficacy of any new antimicrobial device. Nonetheless, current in vivo testing protocols, procedures, models, and assessments are highly disparate, irregularly conducted and reported, and without standardization and validation. The purpose of the present opinion piece is to discuss best practices in preclinical in vivo testing of antimicrobial interventions targeting ODRI. By sharing these experience-driven views, we aim to aid others in conducting such studies both for fundamental biomedical research, but also for regulatory and clinical evaluation.

show abstract

Epidemiology and Resistance Patterns of Bacterial and Fungal Colonization of Biliary Plastic Stents: A Prospective Cohort Study

Cited by 44 publications

References 50 publications

Use of microbiological and patient data for choice of empirical antibiotic therapy in acute cholangitis

Use of microbiological and patient data for choice of empirical antibiotic therapy in acute cholangitis

Risk Factors for Multi-Drug Resistant Pathogens and Failure of Empiric First-Line Therapy in Acute Cholangitis

Recommendations for design and conduct of preclinical in vivo studies of orthopedic device‐related infection

Contact Info

Product

Resources

About