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

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

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Background and objectives: Polymerase chain reaction (PCR) techniques provide rapid detection of pathogens. This pilot study evaluated the diagnostic utility and clini-cal 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-PCRbile and CMCbile results were concordant for only Candida albicans (α=0.8406; Jaccard index=0.8181). mRT-PCRbile detected pathogens in 8/8 cases (100％), CMCbile in 7/8 (87.5％), and CMCblood in 5/8 (62.5％) with clinical signs of infection. mRT-PCRbile, CMCbile, 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-PCRbile than with CMCbile (62 vs. 31; χ2=30.031, p<0.001). However, patho-gens detected by mRT-PCRbile were more often susceptible to pAP according to the patient infection/colonization his-tory (PI/CH) and surveillance data for antibiotic resistance in our clinic (DARC). Pathogens identified by mRT-PCRbile 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 sensitiv-ity 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 unneces-sary administration of broad-spectrum antibiotics.

ERCPPCRAntibiotic prophylaxisCholestasisCholangitis

Michael Jahn、Mustafa K?z?ürümez、Sebastian Dolff、Hana Rohn、Dominik Heider、Alexander Dechêne、Ali Canbay、Peter M.Rath、Antonios Katsounas

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Department of Nephrology,University Hospital Essen,University of Duisburg-Essen,Essen,Germany

Department of Med-icine,Universitätsklinikum Knappschaftskrankenhaus Bochum,Ruhr-University Bochum,Bochum,Germany

Department of Infectious Diseases,University Hospital Essen,University of Duisburg-Essen,Essen,Germany

Department of Mathematics and Computer Science,University of Marburg,Marburg,Germany

Department for Internal Medicine,Nuremberg Hospital North,Paracelsus Private Medical University Nuremberg,Nuremberg,Germany

Institute of Medical Microbiology,Univer-sity Hospital Essen,University of Duisburg-Essen,Essen,Germany

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Open Access Publication Fund of the University of Duisburg-Essen

2022

10.14218/JCTH.2021.00337

临床与转化肝病杂志(英文版)

临床与转化肝病杂志(英文版)

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年,卷(期)：2022.10(5)
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