A Multipathogen Bile Sample-based PCR Assay Can Guide Empirical Antimicrobial Strategies in Cholestatic Liver Diseases  

作　　者：Michael Jahn Mustafa KÖzçürümez Sebastian Dolff Hana Rohn Dominik Heider Alexander Dechêne Ali Canbay Peter M.Rath Antonios Katsounas 

机构地区：[1]Department of Nephrology,University Hospital Essen,University of Duisburg-Essen,Essen,Germany [2]Department of Medicine,Universitätsklinikum Knappschaftskrankenhaus Bochum,Ruhr-University Bochum,Bochum,Germany [3]Department of Infectious Diseases,University Hospital Essen,University of Duisburg-Essen,Essen,Germany [4]Department of Mathematics and Computer Science,University of Marburg,Marburg,Germany [5]Department for Internal Medicine,Nuremberg Hospital North,Paracelsus Private Medical University Nuremberg,Nuremberg,Germany [6]Institute of Medical Microbiology,University Hospital Essen,University of Duisburg-Essen,Essen,Germany

出　　处：《Journal of Clinical and Translational Hepatology》2022年第5期788-795,共8页临床与转化肝病杂志（英文版）

基　　金：support by the Open Access Publication Fund of the University of Duisburg-Essen.

摘　　要：Background and objectives:Polymerase chain reaction(PCR)techniques provide rapid detection of pathogens.This pilot study evaluated the diagnostic utility and clinical impact of multiplex real-time PCR(mRT-PCR,SeptiFast)vs.conventional microbial culture(CMC)in bile samples of patients with chronic cholestatic liver diseases(cCLDs),endoscopic retrograde cholangio-pancreatography(ERCP),and peri-interventional-antimicrobial-prophylaxis(pAP).Methods:We prospectively collected bile samples from 26 patients for microbiological analysis by CMC and mRT-PCR.Concordance of the results of both methods was determined by Krippendorff's alpha(α)for inter-rater reliability and the Jaccard index of similarity.Results:mRT-PCR_(bile)and CMC_(bile)results were concordant for only Candida albicans(α=0.8406;Jaccard index=0.8181).mRT-PCR_(bile)detected pathogens in 8/8 cases(100%),CMC_(bile)in 7/8(87.5%),and CMCblood in 5/8(62.5%)with clinical signs of infection.mRTPCR_(bile),CMC_(bile),and CMCblood had identical detection results in 3/8(37.5%)with clinical signs of infection(two Klebsiella spp.and one Enterococcus faecium).The total pathogen count was significantly higher with mRT-PCR_(bile)than with CMC_(bile)(62 vs.31;χ^(2)=30.031,p<0.001).However,pathogens detected by mRT-PCR_(bile)were more often susceptible to pAP according to the patient infection/colonization history(PI/CH)and surveillance data for antibiotic resistance in our clinic(DARC).Pathogens identified by mRT-PC_(Rbile)and resistant to pAP by PI/CH and DARC were likely to be clinically relevant.Conclusions:mRT-PCR in conjunction with CMCs for bile analysis increased diagnostic sensitivity and may benefit infection management in patients with cholestatic diseases.Implementation of mRT-PCR in a bile sample-based diagnostic routine can support more rapid and targeted use of antimicrobial agents in cCLD-patients undergoing ERCP and reduce the rate/length of unnecessary administration of broad-spectrum antibiotics.

关 键 词：ERCP PCR Antibiotic prophylaxis CHOLESTASIS CHOLANGITIS 

分 类 号：R575[医药卫生—消化系统]