The Epidemiology and Etiology of Cholangitis After Kasai Portoenterostomy in Patients With Biliary Atresia
The Epidemiology and Etiology of Cholangitis After Kasai Portoenterostomy in Patients With Biliary Atresia
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DOI：
10.1097/mpg.0000000000002555
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发表时间：
2020-02-01
影响因子：
2.9
通讯作者：
Ahn, Jong Gyun
中科院分区：
文献类型：
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作者：
Baek, Seung Hwan;Kang, Ji-Man;Ahn, Jong Gyun
目的：研究胆道闭锁患者行加塞门肠吻合术（KPE）后胆管炎的发生率和特点。我们还研究了病原体的分布和抗菌药物敏感性模式，这些病原体是在无菌标本中分离的，如血液和腹水。研究方法：对2006年至2015年在韩国Severance儿童医院接受KPE的胆道闭锁患者进行了回顾性病历审查。Kaplan-Meier法用于评估胆管炎的累积发生率。结果：在纳入的160例患者中，126例（78.8%）患者在研究期间发生了494次胆管炎。KPE术后1年和5年胆管炎的累积发生率分别为75.5%和84.2%，大多数病例（76.2%）胆管炎复发。KPE术后1年和5年经培养证实的胆管炎的累积发病率分别为22.1%和23.9%，屎肠球菌（27.7%）是最常见的病原体，其次是大肠埃希菌（14.9%）、阴沟肠杆菌（10.6%）和肺炎克雷伯菌（8.5%）。革兰阳性菌对氨苄西林和庆大霉素的敏感率分别为42.1%和66.7%，革兰阴性菌对头孢噻肟的敏感率仅为38.1%。结论：本研究是迄今为止最大规模的一项研究，显示了胆道闭锁患者KPE后胆管炎的高发病率和特点，肠球菌是KPE后胆管炎的常见病原体，在选择经验性抗菌治疗时应予以考虑。
Objectives: We investigated the incidence and characteristics of cholangitis after Kasai portoenterostomy (KPE) in patients with biliary atresia. We also examined the distribution and antimicrobial susceptibility patterns of the causative pathogens, which were isolated in sterile specimens, such as blood and ascites. Methods: A retrospective chart review was performed in patients with biliary atresia who underwent KPE at Severance Children's Hospital in Korea from 2006 to 2015. The Kaplan-Meier method was used to assess the cumulative incidence of cholangitis. Results: Among the 160 included patients, there were 494 episodes of cholangitis in 126 patients (78.8%) during the study period. The cumulative incidence of cholangitis at 1 and 5 years after KPE was 75.5% and 84.2%, respectively, and cholangitis recurred in most cases (76.2%). The cumulative incidence of culture-proven cholangitis at 1 and 5 years after KPE was 22.1% and 23.9%, respectively.Enterococcus faecium(27.7%) was the most prevalent pathogen, followed byEscherichia coli(14.9%),Enterobacter cloacae(10.6%), andKlebsiella pneumoniae(8.5%). Gram-positive isolates (n = 19) showed low susceptibility to ampicillin (42.1%) and gentamicin (66.7%), and only 38.1% of Gram-negative isolates (n = 21) were susceptible to cefotaxime. Conclusions: The present study is the largest to show the high incidence and characteristics of cholangitis after KPE in patients with biliary atresia.Enterococcusis a common pathogen of cholangitis after KPE and should be considered when choosing empiric antimicrobial therapy.