Abstract：
OBJECTIVE: Although the biliary tract is a common source of invasive infections, the epidemiology of cholangitis- and cholecystitis-associated bloodstream infection (BSI) is not well defined. The objective of this study was to determine the incidence, clinical determinants, microbiology of biliary tract-associated BSI, and predicted adequacy of common empiric therapy regimens.
METHODS: All biliary tract-associated BSI in Queensland during 2000-2019 were identified using state-wide data sources. Predicted adequacy of empiric antimicrobial therapy was determined according to microbiological susceptibility data.
RESULTS: There were 3,698 episodes of biliary tract-associated BSI occurred in 3,433 patients of which 2,147 (58.1%) episodes were due to cholangitis and 1,551 (41.9%) cholecystitis, for age- and sex-standardized incidence rates of 2.7, and 2.0 per 100,000 population, respectively. An increasing incidence of biliary tract-associated BSI was observed over the study that was attributable to an increase in cholangitis cases. There was a significant increased risk for biliary tract-associated BSI observed with advancing age and male sex. Patients with cholangitis were older, more likely to have healthcare associated infection, and have more comorbidities most notably liver disease and malignancies as compared to patients with cholecystitis. The distribution of infecting pathogens was significantly different with polymicrobial aetiologies more commonly observed with cholangitis (18.4% vs. 10.5%; p < 0.001). The combination of ampicillin/gentamicin/metronidazole was predicted to have the overall highest adequacy (96.1%), whereas amoxicillin/clavulanate had the lowest (77.0%). Amoxicillin/clavulanate (75.2% vs. 79.4%, p:0.03) and ceftriaxone/metronidazole (83.4% vs. 89.6%; p < 0.001) showed significantly inferior predicted adequacy for cholangitis as compared to cholecystitis.
CONCLUSIONS: Bloodstream infections related to cholecystitis and cholangitis exhibit different epidemiology, microbiology, and requirements for empiric therapy.
METHODS: All biliary tract-associated BSI in Queensland during 2000-2019 were identified using state-wide data sources. Predicted adequacy of empiric antimicrobial therapy was determined according to microbiological susceptibility data.
RESULTS: There were 3,698 episodes of biliary tract-associated BSI occurred in 3,433 patients of which 2,147 (58.1%) episodes were due to cholangitis and 1,551 (41.9%) cholecystitis, for age- and sex-standardized incidence rates of 2.7, and 2.0 per 100,000 population, respectively. An increasing incidence of biliary tract-associated BSI was observed over the study that was attributable to an increase in cholangitis cases. There was a significant increased risk for biliary tract-associated BSI observed with advancing age and male sex. Patients with cholangitis were older, more likely to have healthcare associated infection, and have more comorbidities most notably liver disease and malignancies as compared to patients with cholecystitis. The distribution of infecting pathogens was significantly different with polymicrobial aetiologies more commonly observed with cholangitis (18.4% vs. 10.5%; p < 0.001). The combination of ampicillin/gentamicin/metronidazole was predicted to have the overall highest adequacy (96.1%), whereas amoxicillin/clavulanate had the lowest (77.0%). Amoxicillin/clavulanate (75.2% vs. 79.4%, p:0.03) and ceftriaxone/metronidazole (83.4% vs. 89.6%; p < 0.001) showed significantly inferior predicted adequacy for cholangitis as compared to cholecystitis.
CONCLUSIONS: Bloodstream infections related to cholecystitis and cholangitis exhibit different epidemiology, microbiology, and requirements for empiric therapy.
摘要：
目的：虽然胆道是一种常见的侵袭性感染源，胆管炎和胆囊炎相关血流感染(BSI)的流行病学尚不明确.这项研究的目的是确定发病率，临床决定因素，胆道相关BSI的微生物学，并预测常见经验性治疗方案的充分性。
方法：使用全州数据源确定了2000-2019年昆士兰州所有与胆道相关的BSI。根据微生物敏感性数据确定经验性抗菌治疗的预测充分性。
结果：在3,433例患者中发生了3,698次胆道相关BSI发作，其中2,147次（58.1％）发作是由于胆管炎和1,551次（41.9％）胆囊炎。年龄和性别标准化发病率为每10万人2.7和2.0，分别。在研究中观察到胆道相关BSI的发生率增加，这归因于胆管炎病例的增加。随着年龄和男性的增长，胆道相关BSI的风险显着增加。胆管炎患者年龄较大，更有可能有医疗保健相关的感染，与胆囊炎患者相比，有更多的合并症，尤其是肝病和恶性肿瘤。感染病原体的分布与胆管炎更常见的多微生物病因显着不同（18.4％vs.10.5%；p<0.001）。预计氨苄西林/庆大霉素/甲硝唑的组合具有总体最高的充足性（96.1％），而阿莫西林/克拉维酸最低（77.0%）。阿莫西林/克拉维酸（75.2%vs.79.4%,p：0.03）和头孢曲松/甲硝唑（83.4％vs.89.6％；p<0.001）与胆囊炎相比，胆管炎的预测充分性明显较差。
结论：与胆囊炎和胆管炎相关的血流感染表现出不同的流行病学，微生物学,以及经验性治疗的要求。
方法：使用全州数据源确定了2000-2019年昆士兰州所有与胆道相关的BSI。根据微生物敏感性数据确定经验性抗菌治疗的预测充分性。
结果：在3,433例患者中发生了3,698次胆道相关BSI发作，其中2,147次（58.1％）发作是由于胆管炎和1,551次（41.9％）胆囊炎。年龄和性别标准化发病率为每10万人2.7和2.0，分别。在研究中观察到胆道相关BSI的发生率增加，这归因于胆管炎病例的增加。随着年龄和男性的增长，胆道相关BSI的风险显着增加。胆管炎患者年龄较大，更有可能有医疗保健相关的感染，与胆囊炎患者相比，有更多的合并症，尤其是肝病和恶性肿瘤。感染病原体的分布与胆管炎更常见的多微生物病因显着不同（18.4％vs.10.5%；p<0.001）。预计氨苄西林/庆大霉素/甲硝唑的组合具有总体最高的充足性（96.1％），而阿莫西林/克拉维酸最低（77.0%）。阿莫西林/克拉维酸（75.2%vs.79.4%,p：0.03）和头孢曲松/甲硝唑（83.4％vs.89.6％；p<0.001）与胆囊炎相比，胆管炎的预测充分性明显较差。
结论：与胆囊炎和胆管炎相关的血流感染表现出不同的流行病学，微生物学,以及经验性治疗的要求。
