부산대학교 도서관

Objective: In order to manage the antimicrobial treatment of patients with cholangitis/cholecystitis properly, it is very important to predict the potential causative pathogens and their antimicrobial resistance patterns. The aim of this study is to provide data for empirical treatment approaches by identifying the causative agents of biliary tract infections and their antimicrobial susceptibilities, and the risk factors in patients infected with drug-resistant microorganism. Methods: Hospitalized patients with cholangitis/cholecystitis developed primarily or secondary to a biliary tract intervention, and whose bile samples for culture could be obtained, were included in the study during a 9-month period. Bile cultures were incubated in an aerobic environment, and antimicrobial susceptibilities were tested by disk diffusion method. Isolated strains that were resistant to at least two major antimicrobial groups were regarded as 'drug-resistant'. Risk factors for development of infection with a drug-resistant pathogen were evaluated by univariate analysis. Results: A total of 76 bacteria were isolated from 58 bile samples obtained from patients with biliary tract infections. While 30 (39.5%) bacteria were in the drug-resistant group, patients infected with these agents were found to be 26 (44.8%). All drug-resistant strains of Escherichia coli were producing extended-spectrum [beta]-lactamases, and carbapenem resistance was seen among Pseudomonas aeruginosa strains only. Antimicrobial usage during last 3 months before diagnosis (p=0.01) and duration of hospital stay before the infective episode (p=0.03) were found to be risk factors for cholangitis due to drug-resistant agents. Conclusions: In order to guide the empirical treatment of patients with cholangitis/cholecystitis properly, antimicrobial susceptibility patterns of causative agents should be monitored closely and drug-resistant pathogens should be considered in patients with a history of antimicrobial usage during the last 3 months or who have been hospitalized for a long time before the infective episode. Key Words: Cholangitis, cholecystitis, bile culture. Amac: Kolanjit/kolesistit hastalarinda, antimikrobik tedavi seciminin dogru bir sekilde yonlendirilebilmesi icin olasi etken patojenlerin ve bunlarin direnc ozelliklerinin ongorulebilmesi cok onemlidir. Bu calismanin amaci safra yolu infeksiyonlarinda rol alan bakterileri, bu bakterilerin antibiyotiklere duyarliliklarini ve direncli etkenlerle infekte olan hastalardaki risk faktorlerini saptayarak, ampirik tedavi yaklasimlari icin veri saglamaktir. Yontemler: Dokuz aylik bir sure boyunca, primer veya bir safra yolu girisimine bagli olarak gelisen kolanjit/kolesistit nedeniyle yatirilan hastalardan kultur icin safra ornekleri elde edilebilenler calismaya dahil edildi. Safra kulturleri aerop kosullarda inkube edildi; antibiyotik duyarlilik testleri disk difuzyon yontemiyle yapildi. Izole edilen suslardan iki veya daha fazla antibiyotik grubuna direncli olanlar, 'antibiyotige direncli' olarak kabul edildi. Antibiyotige direncli bir patojenle infeksiyon gelismesi acisindan risk faktorleri, tek degiskenli analizlerle arastirildi. Bulgular: Elli sekiz hastadan elde edilen safra orneklerinde toplam 76 bakteri susu izole edildi. Bakterilerin 30 (%39.5)'u antibiyotige direncli grupta yer alirken bu etkenlerle infekte hastalarin sayisi 26 (%44.8)'ydi. Direncli grupta yer alan Escherichia coli suslarinin hepsi genislemis spektrumlu p-laktamaz olustururken, karbapenem direnci sadece Pseudomonas aeruginosa suslarinda goruldu. Hastanin tani oncesindeki 3 ay icerisinde antibiyotik kullanilmis olmasi (p=0.01) ve o infeksiyon atagindan once hastanede yatis suresi (p=0.03), antibiyotige direncli etkenle kolanjit gelisimi acisindan risk faktorleri olarak tanimlandi. Sonuclar: Kolanjit/kolesistit hastalarinin ampirik tedavilerini uygun sekilde yonlendirebilmek icin bu infeksiyonlara neden olan etkenlerin antibiyotiklere duyarlilik ozellikleri yakindan izlenmeli ve son 3 ay icinde antibiyotik kullanma oykusu olan veya infeksiyon atagi oncesinde hastanede yatis suresi uzun olan hastalarda antibiyotige direncli patojenlerin etken olabilecegi akilda tutulmalidir. Anahtar Sozcukler: Kolanjit, kolesistit, safra kulturu.
Giris Kolanjit, 1877 yilinda Charcot tarafindan ates, sarilik ve karin sag ust kadran agrisi triyadiyla tanimlanmis olup biliyer obstruksiyon ve safrada bakteri bulunmasiyla nitelenir. Akut kolesistit ise safra kesesinin sistik [...]